Healthcare Provider Details

I. General information

NPI: 1720331267
Provider Name (Legal Business Name): NEQUEELA NEVETTE DEAS-BLANTON MED, NCC, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 06/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WEST AVE
KANNAPOLIS NC
28081-4332
US

IV. Provider business mailing address

119 WEST AVE
KANNAPOLIS NC
28081-4332
US

V. Phone/Fax

Practice location:
  • Phone: 704-649-0838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA9618
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA90618
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: