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1194349498
QUINTIN BLAYLOCK
RIVERSIDE, CA
NPI
1194349498
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: CA R1326201018)
Enumeration Date
2020-06-02
Last Update Date
2022-11-22
Business Address
QUINTIN BLAYLOCK
2743 ORANGE ST
RIVERSIDE, CA 92501-2503
Phone number: 951-788-9515
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Mailing Address
QUINTIN BLAYLOCK
2743 ORANGE ST
RIVERSIDE, CA 92501-2538
Phone number: 951-788-9515
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