Individual
MS. SHIRLEY R BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
24063 HIGHPOINT RD, BRISTOL, VA 24202-4707
(276) 971-0079
(276) 591-5353
Mailing address
24063 HIGHPOINT RD, BRISTOL, VA 24202-4707
(276) 971-0079
(276) 591-5353
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
—
VA
174400000X
Specialist
Primary
PGP-127280
VA
405300000X
Prevention Professional
10,545
VA
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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