Provider Demographics
NPI:1801781182
Name:BLANTON, ANDREA MONIQUE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MONIQUE
Last Name:BLANTON
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 1:4908 WHETSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4318
Mailing Address - Country:US
Mailing Address - Phone:434-390-8895
Mailing Address - Fax:
Practice Address - Street 1:4908 WHETSTONE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4318
Practice Address - Country:US
Practice Address - Phone:434-390-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA13797-02-008251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health