Provider Demographics
NPI:1427087667
Name:BLINE, CAROL A (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:BLINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:B
Other - Last Name:MANOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7727 AUSTINBURG RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9010
Mailing Address - Country:US
Mailing Address - Phone:614-578-1185
Mailing Address - Fax:
Practice Address - Street 1:4605 MORSE RD STE 201
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-7300
Practice Address - Country:US
Practice Address - Phone:614-578-1165
Practice Address - Fax:614-388-5561
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5339103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities