Provider Demographics
NPI:1659012789
Name:MARGUERITA BLAKER & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MARGUERITA BLAKER & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGUERITA
Authorized Official - Middle Name:SITRIN
Authorized Official - Last Name:BLAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:704-488-4127
Mailing Address - Street 1:2400 CROWNPOINT EXECUTIVE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6726
Mailing Address - Country:US
Mailing Address - Phone:828-680-0466
Mailing Address - Fax:910-782-2026
Practice Address - Street 1:2400 CROWNPOINT EXECUTIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6726
Practice Address - Country:US
Practice Address - Phone:827-680-0466
Practice Address - Fax:910-782-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467847426Medicaid