Healthcare Provider Details

I. General information

NPI: 1932932811
Provider Name (Legal Business Name): REANDRA BLADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E GREEN DR
HIGH POINT NC
27260-6707
US

IV. Provider business mailing address

4212 KING EDWARD CT
GREENSBORO NC
27455-2569
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-7653
  • Fax:
Mailing address:
  • Phone: 336-681-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCO16354
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: