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General NPI Number Information
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NPI Number | 1760016984
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Entity Type | Individual
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Provider Name | SAMIRA BLAND LPC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 275 COUNTRY CLUB DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7349
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Country | US
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Telephone | 770-389-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 315 W PONCE DE LEON AVE STE 300
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City | DECATUR
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State | GA
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Zip | 30030-2481
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Country | US
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Telephone | 770-609-6976
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC014952
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License Number State | GA
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