Provider Demographics
NPI:1215326269
Name:BLANCHARD, JOSEPH WARD (LCAS, MA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WARD
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:LCAS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 PARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3650
Mailing Address - Country:US
Mailing Address - Phone:252-216-9374
Mailing Address - Fax:704-731-0916
Practice Address - Street 1:8100 SIDRAS CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2748
Practice Address - Country:US
Practice Address - Phone:252-216-9374
Practice Address - Fax:704-731-0916
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21259101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)