Blake M Dunham

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

8159-R Issued in CA

Practice address

1149 Warren Ave
Vallejo, CA 94591-7512

Phone

(707) 552-5295

NPI assigned

Apr 4, 2016

Last updated

Jun 7, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Genesis House

  • Addiction (Substance Use Disorder) Counselor
  • Vallejo, CA
  • NPI 1841954856
  NPD (past)
• Genesis House, Inc

  • Substance Abuse Rehabilitation Facility
  • Vallejo, CA
  • NPI 1831265495
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1164885380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 WARREN AVE",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945917512",
            "telephone_number": "707-552-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 WARREN AVE",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945917512",
            "telephone_number": "707-552-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNHAM",
        "first_name": "BLAKE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-04",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "8159-R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CATC",
            "identifier": "8159-R",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessia Dudley
• Ricardo Angel Duenas, PHARM.D
• Karin Bertha Duff
• Jocelyn Ashley Dumlao, CRNA
• Susan Dunaway-Tsujihara, LMFT
• Pattie Jean Dunham
• An Duong
• Lin Duong
• Kevin Brian Duquette, DDS
• Lalaine Durand-Meijer, FNP-C

• Addiction (Substance Use Disorder) Counselor in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.