Provider Demographics
NPI:1073690558
Name:BLAND, EARLY WAYNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EARLY
Middle Name:WAYNE
Last Name:BLAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 E 65TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4421
Mailing Address - Country:US
Mailing Address - Phone:912-355-1440
Mailing Address - Fax:912-352-0802
Practice Address - Street 1:835 E 65TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4421
Practice Address - Country:US
Practice Address - Phone:912-355-1440
Practice Address - Fax:912-352-0802
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0010501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW001050OtherLICENSE NUMBER
GA80BBCRPMedicare ID - Type Unspecified