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General NPI Number Information
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NPI Number | 1235595000
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Entity Type | Individual
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Provider Name | NAKEA S BLAIR CATC II
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Gender | Female
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 165 W HOSPITALITY LN STE 11
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3322
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Country | US
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Telephone | 909-543-6185
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Fax | 909-473-9475
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Provider Business Mailing Address
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Address Line | 165 W HOSPITALITY LN STE 11
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3322
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Country | US
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Telephone | 909-300-2622
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Fax | 909-619-3914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AII051980218
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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