Provider Demographics
NPI:1316607492
Name:BLANCHARD, ANIKI (LCDC)
Entity type:Individual
Prefix:
First Name:ANIKI
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 ROCK PRAIRIE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8652
Mailing Address - Country:US
Mailing Address - Phone:979-599-3958
Mailing Address - Fax:979-485-0674
Practice Address - Street 1:1651 ROCK PAIRIE RD
Practice Address - Street 2:101
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8652
Practice Address - Country:US
Practice Address - Phone:979-599-3585
Practice Address - Fax:979-486-0674
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14197101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)