Provider Demographics
NPI:1629177464
Name:BLONDIN, BETTE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETTE
Middle Name:A
Last Name:BLONDIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JAMES DR
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-3019
Mailing Address - Country:US
Mailing Address - Phone:928-848-1867
Mailing Address - Fax:866-807-4712
Practice Address - Street 1:142 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2711
Practice Address - Country:US
Practice Address - Phone:252-269-5785
Practice Address - Fax:866-807-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0075891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical