Provider Demographics
NPI:1396499901
Name:BLAKE, HUNTER CHRISTIAN (LCMHCA)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:CHRISTIAN
Last Name:BLAKE
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KILDAIRE FARM RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4597
Mailing Address - Country:US
Mailing Address - Phone:919-802-3863
Mailing Address - Fax:
Practice Address - Street 1:1140 KILDAIRE FARM RD STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4597
Practice Address - Country:US
Practice Address - Phone:919-802-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health