Healthcare Provider Details

I. General information

NPI: 1831390582
Provider Name (Legal Business Name): KATHLEEN DELL BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TUOLUMNE ST
VALLEJO CA
94590-5700
US

IV. Provider business mailing address

355 TUOLUMNE ST
VALLEJO CA
94590-5700
US

V. Phone/Fax

Practice location:
  • Phone: 707-553-5331
  • Fax: 707-553-5653
Mailing address:
  • Phone: 707-553-5331
  • Fax: 707-553-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: