Provider Demographics
NPI:1649700584
Name:BLAKE, COURTNEY POPE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:POPE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 DIXIE TRL
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-9307
Mailing Address - Country:US
Mailing Address - Phone:910-331-2616
Mailing Address - Fax:
Practice Address - Street 1:523 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379
Practice Address - Country:US
Practice Address - Phone:910-562-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical