Provider Demographics
NPI:1073124095
Name:BLANCHARD, RONALD DEAN (LCAS, LCMHCA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DEAN
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:LCAS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WOODCROFT CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9140
Mailing Address - Country:US
Mailing Address - Phone:910-382-4120
Mailing Address - Fax:
Practice Address - Street 1:1405A S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2603
Practice Address - Country:US
Practice Address - Phone:252-638-7875
Practice Address - Fax:252-638-7586
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15464101YM0800X
NC1206101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health