Individual
BLAINE LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
R1582051024
Contact information
Practice address
2330 BEVERLY BLVD, LOS ANGELES, CA 90057-2220
(213) 549-8320
Mailing address
2330 BEVERLY BLVD, LOS ANGELES, CA 90057-2220
(213) 549-8320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1582051024
CA
Other
Enumeration date
07/11/2025
Last updated
07/11/2025
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