Individual
KENNETH AARON BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MTS, CCDP
Contact information
Practice address
2600 W 9TH ST, 4TH FLR, CHESTER, PA 19013-2040
(610) 497-7200
Mailing address
3027 W 3RD ST, CHESTER, PA 19013-1805
(610) 859-9556
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5288
PA
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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