Provider Demographics
NPI:1437775566
Name:BLAKE, VORA ONIQUE (LPCC-S)
Entity type:Individual
Prefix:
First Name:VORA
Middle Name:ONIQUE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7659 MALL RD # 1109
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1403
Mailing Address - Country:US
Mailing Address - Phone:859-287-4502
Mailing Address - Fax:859-554-0985
Practice Address - Street 1:75 CAVALIER BLVD STE 218
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3958
Practice Address - Country:US
Practice Address - Phone:859-594-4100
Practice Address - Fax:859-554-0985
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263635103TC1900X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional