Provider Demographics
NPI:1629458187
Name:BLANDSHAW, LINDA CAROL (LCMHC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:BLANDSHAW
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 FAIRVIEW RD STE 702
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3393
Mailing Address - Country:US
Mailing Address - Phone:980-308-4500
Mailing Address - Fax:980-458-6037
Practice Address - Street 1:6849 FAIRVIEW RD STE 702
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3393
Practice Address - Country:US
Practice Address - Phone:980-308-4500
Practice Address - Fax:980-458-6037
Is Sole Proprietor?:No
Enumeration Date:2015-05-31
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11214101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional