Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Justin Laron Blake, LCSW

Individual provider Clinical Social Worker · NPI 1932821956

Justin Laron Blake, LCSW is a Clinical Social Worker in Ellenwood, Georgia. Practices as a sole proprietor. Licensed in Florida and Georgia.

Licensed in
FL, GA
In the registry since
2022
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

2393 Boulder Chase Dr
Ellenwood, GA 30294-1687
Phone: (305) 972-7007
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence SW17317 (FL)
Clinical Social Worker Taxonomy 1041C0700X · Licence CSW007974 (GA)

Record details

NPI number1932821956
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedSeptember 15, 2022
Last updated in NPPESSeptember 15, 2022
Certification dateSeptember 15, 2022

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