Individual
SHAWNTAE MONIQUE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E MAIN ST STE 502, SALISBURY, MD 21801-5079
(667) 281-0094
Mailing address
514 JEFFERSON ST, SALISBURY, MD 21804-3950
(240) 356-3640
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGP14526
MD
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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