Provider Demographics
NPI:1124305305
Name:WORKMAN, BLAKE (MS LPCC, LCPC)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:MS LPCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 CORPORATE WAY
Mailing Address - Street 2:STE 116
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4288
Mailing Address - Country:US
Mailing Address - Phone:937-554-9569
Mailing Address - Fax:
Practice Address - Street 1:7026 CORPORATE WAY
Practice Address - Street 2:STE 116
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4288
Practice Address - Country:US
Practice Address - Phone:937-554-9569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4235101YP2500X
OHE.0900092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional