Individual
JACQUELYN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 NATIONAL HWY, THOMASVILLE, NC 27360-2317
(336) 472-8230
Mailing address
1301 NATIONAL HWY, THOMASVILLE, NC 27360-2317
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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