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1003510769
BENJAMIN WILLIAM BLAIR
SANTA ROSA, CA
NPI
1003510769
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 49-02)
Enumeration Date
2023-03-28
Last Update Date
2023-03-28
Business Address
Mr. BENJAMIN WILLIAM BLAIR R1499800323
625 STEELE LN
SANTA ROSA, CA 95403-3127
Phone number: 707-576-0818
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Mailing Address
Mr. BENJAMIN WILLIAM BLAIR R1499800323
625 STEELE LN
SANTA ROSA, CA 95403-3127
Phone number: 707-576-0818
Copy
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