Provider Demographics
NPI:1952642811
Name:BLAKE, CATHALEEN LYNN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CATHALEEN
Middle Name:LYNN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S ROAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7557
Mailing Address - Country:US
Mailing Address - Phone:423-708-6982
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST STE 203
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7557
Practice Address - Country:US
Practice Address - Phone:423-086-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty