Provider Demographics
NPI:1457970691
Name:BLANCHARD, VICTOR JOSEPH (LGMFT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:JOSEPH
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 QUANTIM CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1895
Mailing Address - Country:US
Mailing Address - Phone:301-712-7631
Mailing Address - Fax:
Practice Address - Street 1:11155 STRATFIELD CT
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1650
Practice Address - Country:US
Practice Address - Phone:410-970-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist