Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ATC003 | MD |
NPI | 1003155078 |
---|---|
Provider Name | Ms. Candace Anne Blase |
First Address | Glenelg, MD 21737-9611 |
Second Address | Columbia, MD 21044-2601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 11/02/2013 |