Blake James Coronado
Counselor, Mental Health in Stockton, CA. Individual provider (NPI-1).
NPI number1194482703
StatusActive
Last updated in NPPESNov 18, 2021
Details
- NPI
- 1194482703
- Entity type
- Individual (NPI-1)
- Name
- Blake James Coronado
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 18, 2021
- Certification date
- Nov 11, 2021
- Last updated
- Nov 18, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
| 106H00000X | Marriage & Family Therapist | – | – | |
| 104100000X | Social Worker | – | – |
Practice location
2495 W March LnStockton, CA 95207-8251
Phone 209-271-3218
Mailing address
2495 W March LnStockton, CA 95207-8251
Phone 209-271-3218
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All 422 Mental Health Counselor providers in Stockton · All 11,041 providers in Stockton
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