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75 Cavalier Blvd Ste 218 Florence KY 41042-3958 | |
| (859) 594-4100 | |
| (859) 554-0985 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 75 Cavalier Blvd Ste 218, Florence, Kentucky |
| Authorized Official Name and Position | Vora Onique Blake (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8592874502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7659 Mall Rd # 1109 Florence KY 41042-1403 Ph: (859) 287-4502 | 75 Cavalier Blvd Ste 218 Florence KY 41042-3958 Ph: (859) 594-4100 |
| NPI Number | 1750096814 |
|---|---|
| Provider Enumeration Date | 01/23/2023 |
| Last Update Date | 05/26/2024 |
| Certification Date | 05/26/2024 |
| Medicare PECOS PAC ID | 4385179134 |
|---|---|
| Medicare Enrollment ID | O20241203001562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750096814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Vora Onique Blake |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437775566 PECOS PAC ID: 5294260048 Enrollment ID: I20241203001649 |
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