Individual
BLAKE ANTHONY LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 TEMPLE TER, CLARKSBURG, WV 26301-4018
(304) 709-8636
Mailing address
210 TEMPLE TER, CLARKSBURG, WV 26301-4018
(304) 709-8636
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
12/24/2020
Last updated
12/24/2020
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