Provider Demographics
NPI:1902049844
Name:BLANEY, ANA RITA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:RITA
Last Name:BLANEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 LAUREN PLACE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2114
Mailing Address - Country:US
Mailing Address - Phone:910-352-7034
Mailing Address - Fax:
Practice Address - Street 1:615 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6431
Practice Address - Country:US
Practice Address - Phone:910-343-0145
Practice Address - Fax:910-341-5779
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2018-03-17
Deactivation Date:2011-08-22
Deactivation Code:
Reactivation Date:2016-03-14
Provider Licenses
StateLicense IDTaxonomies
NCC0086101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902049844Medicaid