Provider Demographics
NPI:1629580535
Name:BLUME, MICHAEL L (MS, NCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:BLUME
Suffix:
Gender:M
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2154
Mailing Address - Country:US
Mailing Address - Phone:302-762-8989
Mailing Address - Fax:302-762-8987
Practice Address - Street 1:507 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2154
Practice Address - Country:US
Practice Address - Phone:302-762-8989
Practice Address - Fax:302-762-8987
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health