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General NPI Number Information
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NPI Number | 1427087667
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Entity Type | Individual
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Provider Name | CAROL A BLINE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 4605 MORSE RD STE 201
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City | GAHANNA
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State | OH
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Zip | 43230-7300
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Country | US
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Telephone | 614-578-1165
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Fax | 614-388-5561
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Provider Business Mailing Address
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Address Line | 7727 AUSTINBURG RD
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City | ASHTABULA
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State | OH
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Zip | 44004-9010
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Country | US
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Telephone | 614-578-1185
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 5339
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 5339
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5339
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 5339
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 5339
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5339
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License Number State | OH
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