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Individual
BLAKE ANDREW SHUPE
Active
Individual
BLAKE ANDREW SHUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AOD COUNSELOR
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7581
CADTP
CA
Enumeration date
09/11/2018
Last updated
09/11/2018
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