Provider Demographics
NPI:1740861483
Name:BLUM, ANIKA
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:BLUM
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 1:13 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-5338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 PEACH ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:GA
Practice Address - Zip Code:31006-5338
Practice Address - Country:US
Practice Address - Phone:404-430-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst