Individual
DIANA D BLANDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,QMHP
Contact information
Practice address
4000 GENESEE PL STE 101, WOODBRIDGE, VA 22192-8302
(571) 659-0056
Mailing address
1616 KENTUCKY AVE, WOODBRIDGE, VA 22191-3658
(540) 303-1217
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0906011240
VA
1041C0700X
Clinical Social Worker
0906011240
VA
251B00000X
Case Management Agency
0733003450
VA
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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