Justin Blake's National Provider Identifier (NPI) Details
Justin Blake, LCSW
NPI: 1932821956
Enumeration Date: 2022-09-15
Last updated: 2022-09-15
Sole Proprietor: YES
Status: active
Postal Address: 2393 BOULDER CHASE DR, ELLENWOOD, GA
Phone: 305-972-7007
Primary Practice Address: 2393 BOULDER CHASE DR, ELLENWOOD, GA
Practice's phone: 305-972-7007