Provider Demographics
NPI:1487889499
Name:HARBIN, BLAKE CAROL ANN
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:CAROL ANN
Last Name:HARBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4017
Mailing Address - Country:US
Mailing Address - Phone:510-251-3962
Mailing Address - Fax:510-251-3954
Practice Address - Street 1:969 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4017
Practice Address - Country:US
Practice Address - Phone:510-251-3962
Practice Address - Fax:510-251-3954
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68349101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health