Provider Demographics
NPI:1063917110
Name:WHISNANT, BLAIR HOLLIFIELD (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:HOLLIFIELD
Last Name:WHISNANT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RIDGEWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-1847
Mailing Address - Country:US
Mailing Address - Phone:704-284-3620
Mailing Address - Fax:
Practice Address - Street 1:4913 PROFESSIONAL CT STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1926
Practice Address - Country:US
Practice Address - Phone:704-284-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician