Individual
KING BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.P.C.
Contact information
Practice address
1317 E NORTH AVE, BALTIMORE, MD 21213-1405
(410) 240-0785
Mailing address
1317 E NORTH AVE, BALTIMORE, MD 21213-1405
(410) 240-0785
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
LC4136
MD
Other
Enumeration date
09/09/2011
Last updated
09/28/2021
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