Healthcare Provider Details

I. General information

NPI: 1770017659
Provider Name (Legal Business Name): CHA'RAY BLAND M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHA'RAY S STEPHENS

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11016 BROADBENT CT
CHARLOTTE NC
28278-7554
US

IV. Provider business mailing address

11016 BROADBENT CT
CHARLOTTE NC
28278-7554
US

V. Phone/Fax

Practice location:
  • Phone: 313-953-9792
  • Fax:
Mailing address:
  • Phone: 313-953-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22206
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.9553
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC12885
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: