Individual
EDNA LOUISE BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
120 PENMARC DR, SUITE 118, RALEIGH, NC 27603-2400
(800) 632-6074
(800) 632-6079
Mailing address
PO BOX 10414, LARGO, FL 33773-0414
(800) 632-6074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C001018
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6003263
—
NC
01
—
P00332196
RR MEDICARE WITH PARADIGM
NC
Enumeration date
09/14/2006
Last updated
08/26/2010
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