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Individual
AMANDA MARIE BLAKE
Active
Individual
AMANDA MARIE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, MSSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
4753
ND
104100000X
Social Worker
50864
TX
1041C0700X
Clinical Social Worker
Primary
4753
ND
Other
Enumeration date
09/24/2008
Last updated
10/31/2022
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