Provider Demographics
NPI:1649427782
Name:BLAND, TEMPIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:TEMPIE
Middle Name:
Last Name:BLAND
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 1:111 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-2578
Mailing Address - Country:US
Mailing Address - Phone:601-629-9419
Mailing Address - Fax:
Practice Address - Street 1:111 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-2578
Practice Address - Country:US
Practice Address - Phone:601-629-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC17291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical