Individual
CHRISTOPHER BLAKE GLAZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 GORDON COMMERCIAL DR STE C, LAGRANGE, GA 30240-5754
(706) 845-4045
Mailing address
709 S 12TH ST, LANETT, AL 36863-2831
(706) 590-2839
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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