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General NPI Number Information
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NPI Number | 1932873866
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Entity Type | Individual
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Provider Name | ALEXANDRA BLANCO
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 3012 FALSTAFF RD
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City | RALEIGH
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State | NC
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Zip | 27610-1813
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Country | US
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Telephone | 919-615-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 4122 CHINESE FIR TRL
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City | RALEIGH
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State | NC
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Zip | 27610-6656
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Country | US
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Telephone | 910-627-7368
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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 | P016673
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License Number State | NC
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