1407185648 NPI number — MRS. JA'SHAUN BRAILEY BLANDING LCSWA

Table of content: MRS. JA'SHAUN BRAILEY BLANDING LCSWA (NPI 1407185648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407185648 NPI number — MRS. JA'SHAUN BRAILEY BLANDING LCSWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANDING
Provider First Name:
JA'SHAUN
Provider Middle Name:
BRAILEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407185648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/28/2011
NPI Reactivation Date:
06/13/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3540 TORINGDON WAY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-3867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-575-7816
Provider Business Mailing Address Fax Number:
980-217-8025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3540 TORINGDON WAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-3867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-575-7816
Provider Business Practice Location Address Fax Number:
980-217-8025
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  P020362 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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