Most Relevant Information
Provider Data
| NPI Number: | 1003044066 |
| Provider Name: | TIMOTHY CARL BLAKE |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/29/2009 |
| Last Updated: | 06/29/2009 |
Provider Practice Location
725 HIGHLAND AVE
WINSTON SALEM
NC
271014206
Practice Location Phone/Fax
| Phone: | 3366078523 |
| Fax: |
Provider Mailing Location
284 EXECUTIVE PARK DR
SUITE 100
CONCORD
NC
280251831
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |