Provider Demographics
NPI:1790906600
Name:BLAKELY, DELORES (BA)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G-3163 FLUSHING RD
Mailing Address - Street 2:#106
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504
Mailing Address - Country:US
Mailing Address - Phone:810-249-9924
Mailing Address - Fax:
Practice Address - Street 1:G-3163 FLUSHING RD
Practice Address - Street 2:#106
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504
Practice Address - Country:US
Practice Address - Phone:810-249-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)