Individual
JEREMY BRENT BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
214 S 4TH ST, IRONTON, OH 45638-1610
(740) 532-3767
(740) 532-3385
Mailing address
214 S 4TH ST, IRONTON, OH 45638-1610
(740) 532-3767
(740) 532-3385
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.181009
OH
171M00000X
Case Manager/Care Coordinator
—
OH
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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