Individual
BLAKE QUINTON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Mailing address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ACSW93874
CA
1041C0700X
Clinical Social Worker
ASW93874
CA
Other
Enumeration date
11/08/2016
Last updated
11/21/2024
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