Individual
ANNA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5121 KINGDOM WAY, RALEIGH, NC 27607-6062
(800) 442-2762
Mailing address
175 S HARVEST RIDGE WAY, CLAYTON, NC 27520-4864
(910) 429-4943
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
3348
NC
Other
Enumeration date
12/09/2021
Last updated
09/17/2025
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