Provider Demographics
NPI:1992372957
Name:STANTON, BLAIR ALEXANDRA
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:ALEXANDRA
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:ALEXANDRA
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:247 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-7320
Mailing Address - Country:US
Mailing Address - Phone:615-314-3292
Mailing Address - Fax:
Practice Address - Street 1:247 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7320
Practice Address - Country:US
Practice Address - Phone:615-314-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician