Provider Demographics
NPI:1619938537
Name:BLANTON, P GREGG (EDD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:GREGG
Last Name:BLANTON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2330
Mailing Address - Country:US
Mailing Address - Phone:828-712-9704
Mailing Address - Fax:828-258-3831
Practice Address - Street 1:191 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2330
Practice Address - Country:US
Practice Address - Phone:828-712-9704
Practice Address - Fax:828-258-3831
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2983101YP2500X
NC697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1140VOtherBCBSNC
NC2014731OtherCIGNA BEHAVIORAL
NCC4264OtherMEDCOST