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Individual
MR. JAMES EVAN LAKE
Active
Individual
MR. JAMES EVAN LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, PC, ATR
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.0008277
OH
221700000X
Art Therapist
21-169
OH
Other
Enumeration date
12/18/2021
Last updated
12/18/2021
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