Individual
JACQUELINE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8221 WILLOW OAKS CORPORATE DR, 2-217E.01, FAIRFAX, VA 22031-4512
(703) 207-6976
(703) 653-7008
Mailing address
8221 WILLOW OAKS CORPORATE DR, 2-217E.01, FAIRFAX, VA 22031-4512
(703) 207-6976
(703) 653-7008
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904009033
VA
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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