Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003162827 |
---|---|
Provider Name | Laura Blackburn |
First Address | Dublin, CA 94568-3403 |
Second Address | Dublin, CA 94568-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 09/06/2015 |