Provider Demographics
NPI:1245061829
Name:BLAKE, BRITTANY (QMHP, LPC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:QMHP, LPC
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:B
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP, LPC
Mailing Address - Street 1:813 TWO BROTHERS LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-8962
Mailing Address - Country:US
Mailing Address - Phone:804-661-8258
Mailing Address - Fax:
Practice Address - Street 1:813 TWO BROTHERS LN
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-8962
Practice Address - Country:US
Practice Address - Phone:804-661-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA734010414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty