TREVOR GLENN BLAKE

MERCED, CA
NPI1447077375
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: CA  R1573850824)
Enumeration Date2024-09-23
Last Update Date2024-09-23
Business Address
TREVOR GLENN BLAKE RADT
301 E 13TH ST
MERCED, CA 95341-6211
Phone number: 209-381-6800
Mailing Address
TREVOR GLENN BLAKE RADT
7560 FAIRLANE AVE
WINTON, CA 95388-9376
Phone number: 209-349-1311
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