Fayetta Michelle Bland, MBA, MA, LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1322 Space Park Dr Ste C145
Houston, TX 77058-3542

Phone

(832) 864-3347

NPI assigned

Feb 17, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts, Master of Business Administration

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Divine Counseling Service, LLC

  • Adult Mental Health Clinic/Center
  • Houston, TX
  • NPI 1609573518

  Addiction (Substance Use Disorder)

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1386342574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6603 HOPPER RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770162226",
            "telephone_number": "832-758-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 SPACE PARK DR STE C145",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770583542",
            "telephone_number": "832-864-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAND",
        "first_name": "FAYETTA",
        "middle_name": "MICHELLE",
        "credential": "MBA, MA, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Jonathan Blanco, APRN
• Nestor Blanco
• Sheila Blanco
• Daniel Stewart Bland, MD
• Emily Magness Bland, MS
• Mary-Ann Maama Bland, LCSW
• Renee Bland
• Susan Blaney, MD
• Brennan Ashley Blankenship
• Kerry Craighill Blankenship, DPT

• Addiction (Substance Use Disorder) Counselor in Houston, TX
• Providers in Houston, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.