Provider Demographics
NPI:1114268786
Name:BLANCHARD, WILNER (MED, MA; RMHCI)
Entity Type:Individual
Prefix:
First Name:WILNER
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:MED, MA; RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 RENWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818
Mailing Address - Country:US
Mailing Address - Phone:407-574-7723
Mailing Address - Fax:407-574-7723
Practice Address - Street 1:7732 RENWOOD CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-1237
Practice Address - Country:US
Practice Address - Phone:407-574-7723
Practice Address - Fax:407-574-7723
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health