Provider Demographics
NPI:1457457285
Name:BLANKS, CONSTANCE PFISTER (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:PFISTER
Last Name:BLANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:CARLTON
Other - Last Name:PFISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6815-202 FAYETTEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-544-3907
Mailing Address - Fax:
Practice Address - Street 1:6815 FAYETTEVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7082
Practice Address - Country:US
Practice Address - Phone:919-544-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0023761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003258Medicaid
NC6003258Medicaid