Individual
SHERRY L BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1897 GODBY RD, ATLANTA, GA 30349-5235
(770) 996-7622
Mailing address
1897 GODBY RD, ATLANTA, GA 30349-5235
(770) 996-7622
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001267
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000431395A
—
GA
Enumeration date
04/18/2007
Last updated
07/01/2008
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