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Individual
MR. MARK WADE BLAKELEY
Active
Individual
MR. MARK WADE BLAKELEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSC, EMT-P
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
CO
146L00000X
Paramedic
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2791
PARAMEDIC CERTIFICATION
CO
Enumeration date
02/18/2008
Last updated
02/26/2010
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