Individual
MR. BENJAMIN WILLIAM BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R1499800323
Contact information
Practice address
625 STEELE LN, SANTA ROSA, CA 95403-3127
(707) 576-0818
(707) 576-7845
Mailing address
625 STEELE LN, SANTA ROSA, CA 95403-3127
(707) 576-0818
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
49-02
CA
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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