Individual
BLAKE DERON GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8915 HARRY HINES BLVD, DALLAS, TX 75235-1717
(972) 837-9667
Mailing address
8915 HARRY HINES BLVD, DALLAS, TX 75235-1717
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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