Provider Demographics
NPI:1932708062
Name:BLALOCK, DANIEL VANHOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VANHOY
Last Name:BLALOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 LIPSCOMB DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-9287
Mailing Address - Country:US
Mailing Address - Phone:704-985-0407
Mailing Address - Fax:
Practice Address - Street 1:411 W CHAPEL HILL ST STE 600
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3270
Practice Address - Country:US
Practice Address - Phone:704-985-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty