Provider Demographics
NPI:1932298072
Name:BLANDING, MICHELLE LOQUITTA
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LOQUITTA
Last Name:BLANDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 AZTEC PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6112
Mailing Address - Country:US
Mailing Address - Phone:910-868-7478
Mailing Address - Fax:
Practice Address - Street 1:711 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5193
Practice Address - Country:US
Practice Address - Phone:910-323-2311
Practice Address - Fax:910-678-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health