Amanda Mae Blake

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

186070 Issued in OH

Practice address

1 Elizabeth PL Ste Nwb40
Dayton, OH 45417-3445

Phone

(937) 401-8672

NPI assigned

Oct 18, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Miami Valley Recovery, LLC

  • Community/Behavioral Health Agency
  • Dayton, OH
  • NPI 1285152496
  NPD
• Miami Valley Recovery, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayton, OH
  • NPI 1831947340
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1306509211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 SPRINGFIELD ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454031430",
            "telephone_number": "937-802-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELIZABETH PL STE NWB40",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454173445",
            "telephone_number": "937-401-8672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "AMANDA",
        "middle_name": "MAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "186070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0466273",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Alan Blaine, LSW
• Charles J Blair Jr., LMT
• Raylyn Blair
• Ryanna Blair, BA, QMHS
• William C Blair
• Joseph Blake, MD
• Parese Blake
• Samantha Paige Blake, RPH
• Tiffany E Blake
• Wilton E. Blake I, D.MIN/BCC

• Addiction (Substance Use Disorder) Counselor in Dayton, OH
• Providers in Dayton, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.