Individual
COREY BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 NAPA VALLEJO HWY, NAPA, CA 94558
(707) 253-5000
Mailing address
2100 NAPA VALLEJO HWY, NAPA, CA 94558
(707) 253-5000
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT37569
CA
Other
Enumeration date
09/01/2016
Last updated
09/19/2016
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