Individual
DIA LAQUAN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
398 W BAGLEY RD, BEREA, OH 44017-1369
(216) 340-0011
Mailing address
706 E 96TH ST, CLEVELAND, OH 44108-1206
(216) 258-4300
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/25/2022
Last updated
01/25/2022
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