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1548922537
NICHOLAS BLAKE
FULLERTON, CA
NPI
1548922537
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1446301021)
Enumeration Date
2021-10-07
Last Update Date
2021-10-07
Business Address
NICHOLAS BLAKE RADT
771 W ORANGETHORPE AVE
FULLERTON, CA 92832-2806
Phone number: 714-879-0929
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Mailing Address
NICHOLAS BLAKE RADT
771 W ORANGETHORPE AVE
FULLERTON, CA 92832-2806
Phone number: 714-879-0929
Copy
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