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General NPI Number Information
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NPI Number | 1659962652
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Entity Type | Individual
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Provider Name | BLANCA GODINEZ
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Gender | Female
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 790 S STATE ST STE 6
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City | SAN JACINTO
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State | CA
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Zip | 92583-4924
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Country | US
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Telephone | 951-654-6002
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Fax |
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Provider Business Mailing Address
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Address Line | 25765 ECHO VALLEY RD
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City | HOMELAND
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State | CA
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Zip | 92548-9619
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Country | US
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Telephone | 951-293-9455
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Fax |
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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 | R1571920724
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 126624
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License Number State |
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