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1447077375
TREVOR GLENN BLAKE
MERCED, CA
NPI
1447077375
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1573850824)
Enumeration Date
2024-09-23
Last Update Date
2024-09-23
Business Address
TREVOR GLENN BLAKE RADT
301 E 13TH ST
MERCED, CA 95341-6211
Phone number: 209-381-6800
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Mailing Address
TREVOR GLENN BLAKE RADT
7560 FAIRLANE AVE
WINTON, CA 95388-9376
Phone number: 209-349-1311
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