Individual
MS. GAIL JOAN BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC 1
Contact information
Practice address
50 ALDRIN RD, PLYMOUTH, MA 02360
(508) 830-0004
(508) 830-0295
Mailing address
PO B 3163, WAQUIOT, MA 02536
(508) 548-1349
(508) 548-1349
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1008
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008
LICENSE NUMBER
MA
Enumeration date
12/06/2006
Last updated
07/08/2007
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