Individual
MR. ANTHONY JEROME BLALOCK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S. QMHP
Contact information
Practice address
210 LILY WAY APT 3B, PETERSBURG, VA 23805-9161
(757) 770-8214
Mailing address
210 LILY WAY APT 3B, PETERSBURG, VA 23805-9161
(757) 770-8214
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/12/2018
Last updated
01/12/2018
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