Individual
FAYETTA MICHELLE BLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MBA, MA, LCDC
Contact information
Practice address
1322 SPACE PARK DR STE C145, HOUSTON, TX 77058-3542
(832) 864-3347
Mailing address
6603 HOPPER RD, HOUSTON, TX 77016-2226
(832) 758-1565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/17/2023
Last updated
02/17/2023
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