Individual
BLAKE M DUNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1149 WARREN AVE, VALLEJO, CA 94591-7512
(707) 552-5295
Mailing address
1149 WARREN AVE, VALLEJO, CA 94591-7512
(707) 552-5295
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
8159-R
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8159-R
CATC
CA
Enumeration date
04/04/2016
Last updated
06/07/2016
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