Christopher Blake Glaze

NPI #1104464296 in Lagrange, Georgia

Provider Information

NPI Number: 1104464296
Entity Type: Individual
Name: Christopher Blake Glaze
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Professional
Enumeration Date: Dec 19, 2019
Last Updated: Dec 19, 2019

Practice Location

Address: 122 GORDON COMMERCIAL DR STE C
City: Lagrange
State: Georgia
ZIP Code: 30240-5754
Phone: (706) 845-4045

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Professional — Professional	101YP2500X	Primary

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