Justin Laron Blake, LCSW
Social Worker, Clinical in Ellenwood, GA. Individual provider (NPI-1).
NPI number1932821956
StatusActive
Last updated in NPPESSep 15, 2022
Details
- NPI
- 1932821956
- Entity type
- Individual (NPI-1)
- Name
- Justin Laron Blake
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 15, 2022
- Certification date
- Sep 15, 2022
- Last updated
- Sep 15, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | SW17317 | FL | Yes |
| 1041C0700X | Social Worker, Clinical | CSW007974 | GA |
Practice location
2393 Boulder Chase DrEllenwood, GA 30294-1687
Phone 305-972-7007
Mailing address
2393 Boulder Chase DrEllenwood, GA 30294-1687
Phone 305-972-7007
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