MEDICARE: MRS. ERIN KAY BLAND LSCW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C007279	NC

General Provider Information

NPI Number	:	1922380674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN KAY BLAND LSCW

Provider Business Mailing Address
First Line	:	1601 JONES FRANKLIN RD STE 104
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3379
Country	:	US
Telephone Number	:	919-851-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 JONES FRANKLIN RD STE 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3351
Country	:	US
Telephone Number	:	919-851-3555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	12/28/2011

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