Individual
NICOLE E BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LADC
Contact information
Practice address
40 BRACKETT ST APT 3, WESTBROOK, ME 04092-3383
(603) 860-4900
Mailing address
40 BRACKETT ST APT 3, WESTBROOK, ME 04092-3383
(603) 860-4900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC7566
ME
1041C0700X
Clinical Social Worker
2905
NH
1041C0700X
Clinical Social Worker
Primary
LC21397
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2077079813
INDIV NPI
—
Enumeration date
04/25/2020
Last updated
10/30/2023
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