Provider Demographics
NPI:1831681006
Name:HARPER, BLAKELY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:BLAKELY
Middle Name:ELIZABETH
Last Name:HARPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 NOBLE WAY STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7444
Mailing Address - Country:US
Mailing Address - Phone:229-333-0300
Mailing Address - Fax:229-333-0306
Practice Address - Street 1:3350 NOBLE WAY STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605
Practice Address - Country:US
Practice Address - Phone:229-333-0300
Practice Address - Fax:229-333-0306
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical