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Individual

COREY DASHAUN BLAKE SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
40 GOODWILL RD, LECOMPTE, LA 71346
(318) 470-9531
Mailing address
PO BOX 581, LECOMPTE, LA 71346-0581
(318) 470-9531

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
10/16/2017
Last updated
05/17/2018
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