VIRGINIA L BLAKE, LADC, CCS, LSW CALAIS, ME

Contact Information

VIRGINIA L BLAKE, LADC, CCS, LSW

127 PALMER ST
CALAIS, ME 04619-1300

Phone: 207-454-0270
Fax: 207-454-0232
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Addiction (Substance Use Disorder)	101YA0400X

Indicates primary specialty

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NPI Profile & details for VIRGINIA L BLAKE · (Female)

NPI #	`1659638955`
Status	Active
Credentials	LADC, CCS, LSW
Entity	Individual
Enumeration date	04/12/2012
Last updated	04/12/2012 - About 14 years ago
Sole proprietor ¹	No
Identifiers	ME License # LC3675 ME Medicaid 103850000
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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