Active NPI
Robert Blondeau
- Professional Counselor
- Atlanta, GA
National Provider Identifier
1023494697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- APC004562
- Practice address
- 3116 Maple Dr NE
Atlanta, GA 30305-2608 - Phone
- (718) 909-0019
- NPI assigned
- Aug 6, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | APC004562 | GA | Primary |
Addresses
Primary practice location
3116 Maple Dr NE
Atlanta, GA 30305-2608
Mailing address
2556 Woodridge Dr
Decatur, GA 30033-4834
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APC004562 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438819200000",
"number": "1023494697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2556 WOODRIDGE DR",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3116 MAPLE DR NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303052608",
"telephone_number": "718-909-0019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLONDEAU",
"first_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-06",
"last_updated": "2015-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "APC004562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.