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General NPI Number Information
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NPI Number | 1225142342
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Entity Type | Individual
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Provider Name | ERICA WYMAN BLYSTONE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 103 MARKET ST
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City | CHAPEL HILL
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State | NC
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Zip | 27516-4071
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Country | US
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Telephone | 919-929-1375
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Fax | 919-929-0711
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Provider Business Mailing Address
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Address Line | 1725 TW ALEXANDER DR #1006
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City | DURHAM
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State | NC
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Zip | 27703
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Country | US
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Telephone | 919-724-3937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004490
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License Number State | NC
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