Provider Demographics
NPI:1245980291
Name:BLAND, CHARAE (THERAPIST)
Entity type:Individual
Prefix:MS
First Name:CHARAE
Middle Name:
Last Name:BLAND
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S UNION ST APT 204
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-3243
Mailing Address - Country:US
Mailing Address - Phone:219-506-3116
Mailing Address - Fax:
Practice Address - Street 1:4747 W 24TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-2821
Practice Address - Country:US
Practice Address - Phone:219-240-8615
Practice Address - Fax:219-977-1197
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker