Individual
VICTORIA HALL BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
412 SURRY CT, JACKSONVILLE, NC 28540-3955
(910) 340-1833
Mailing address
412 SURRY CT, JACKSONVILLE, NC 28540-3955
(910) 340-1833
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-067-220
NC
Other
Enumeration date
02/20/2026
Last updated
02/20/2026
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