Provider Demographics
NPI:1396282471
Name:BLANCHARD, CRYSTAL RENEE (MA LCPC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PIGPEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658-1158
Mailing Address - Country:US
Mailing Address - Phone:410-304-2449
Mailing Address - Fax:
Practice Address - Street 1:155 LOG CANOE CIR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2127
Practice Address - Country:US
Practice Address - Phone:410-604-0226
Practice Address - Fax:877-643-0126
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional