Individual
MR. STEPHEN DALE BLAKEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
1012 CEDAR KNOLL DR, WAKE FOREST, NC 27587-6248
(919) 554-4343
(877) 300-6893
Mailing address
1012 CEDAR KNOLL DR, WAKE FOREST, NC 27587-6248
(919) 554-4343
(877) 300-6893
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1556
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142A0
BCBS
NC
05
—
6107254
—
NC
Enumeration date
06/13/2005
Last updated
05/20/2008
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