Provider Demographics
NPI:1316729866
Name:BLANKENSHIP, LACHARLA MICHELLE
Entity type:Individual
Prefix:
First Name:LACHARLA
Middle Name:MICHELLE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0275
Mailing Address - Country:US
Mailing Address - Phone:740-701-0111
Mailing Address - Fax:740-701-0111
Practice Address - Street 1:219 W EMMITT AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1181
Practice Address - Country:US
Practice Address - Phone:937-544-2222
Practice Address - Fax:740-701-0111
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185312101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)