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Individual
MR. BLAINE LAMONT EDWARDS JR.
Active
Individual
MR. BLAINE LAMONT EDWARDS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6173792-6004
UT
Other
Enumeration date
06/05/2022
Last updated
06/05/2022
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