Provider Demographics
NPI:1114734498
Name:ARMSTRONG, BLAKE (LPC, MED)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 BALIN LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7900
Mailing Address - Country:US
Mailing Address - Phone:770-825-2881
Mailing Address - Fax:
Practice Address - Street 1:5203 BALIN LN
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7900
Practice Address - Country:US
Practice Address - Phone:770-825-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional