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Individual
BLAKE JAMES CORONADO
Active
Individual
BLAKE JAMES CORONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
11/18/2021
Last updated
11/18/2021
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