Individual
CHARLETHA RENEE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
204 MUIRS CHAPEL RD STE 136, GREENSBORO, NC 27410-6173
(336) 962-6200
Mailing address
2328 MILL LN, HIGH POINT, NC 27265-9184
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
P020061
NC
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/24/2019
Last updated
04/14/2026
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