Provider Demographics
NPI:1043506702
Name:BLANCHARD, MARJORIE LYNN (MTS, NCAC)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:LYNN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MTS, NCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 WILLO LN
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4645
Mailing Address - Country:US
Mailing Address - Phone:949-313-1192
Mailing Address - Fax:
Practice Address - Street 1:2607 WILLO LN
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4645
Practice Address - Country:US
Practice Address - Phone:949-313-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)