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Individual
VIRGINIA L. BLAKE
Active
Individual
VIRGINIA L. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, CCS, LSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC3675
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103850000
—
ME
Enumeration date
04/12/2012
Last updated
04/12/2012
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