Provider Demographics
NPI:1316603830
Name:BLANDING, ANGEL MARIA
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIA
Last Name:BLANDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 WILLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7962
Mailing Address - Country:US
Mailing Address - Phone:803-609-7981
Mailing Address - Fax:
Practice Address - Street 1:1128 WILLOW OAK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7962
Practice Address - Country:US
Practice Address - Phone:803-609-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8781321OtherBUTTERFLY EFFECTS