Provider Demographics
NPI:1942799812
Name:BLACKWELDER, MARGARET JOLEA
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:JOLEA
Last Name:BLACKWELDER
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 1:7910 HORSE CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9810
Mailing Address - Country:US
Mailing Address - Phone:704-619-0981
Mailing Address - Fax:
Practice Address - Street 1:2301 CROWNPOINT EXECUTIVE DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6725
Practice Address - Country:US
Practice Address - Phone:704-708-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-16-26236106S00000X
NC1-20-40794103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty