Provider Demographics
NPI:1629458187
Name:BLANDSHAW, LINDA CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:BLANDSHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99036
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-9036
Mailing Address - Country:US
Mailing Address - Phone:919-277-0253
Mailing Address - Fax:
Practice Address - Street 1:8152 SIX FORKS RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-277-0253
Practice Address - Fax:919-277-4627
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-31
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional