Provider Demographics
NPI:1609536903
Name:BLAKE, KRISTINE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CHRISTIANA RD APT R6
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-2938
Mailing Address - Country:US
Mailing Address - Phone:302-333-7996
Mailing Address - Fax:
Practice Address - Street 1:3001 PHILADELPHIA PIKE STE 1
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2580
Practice Address - Country:US
Practice Address - Phone:844-222-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC-0011784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional