Individual
MR. MARK R BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., SR. LPE
Contact information
Practice address
1009 ASH CIR, LA VERGNE, TN 37086-4157
(615) 793-6513
Mailing address
1009 ASH CIR, LA VERGNE, TN 37086-4157
(615) 793-6513
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PE0000011423
TN
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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