Individual
BLAKE JAMES CORONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2495 W MARCH LN, STOCKTON, CA 95207-8251
(209) 271-3218
Mailing address
2495 W MARCH LN, STOCKTON, CA 95207-8251
(209) 271-3218
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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