Individual
MR. GEOFFREY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24682 CHANTILLY LN, DAPHNE, AL 36526-8730
(251) 591-4740
Mailing address
24682 CHANTILLY LN, DAPHNE, AL 36526-8730
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
17802
AL
Other
Enumeration date
01/30/2020
Last updated
01/30/2020
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