Most Relevant Information
Provider Data
| NPI Number: | 1003408808 |
| Provider Name: | BRENDA BLAKE-JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/03/2021 |
| Last Updated: | 02/03/2021 |
Provider Practice Location
2423 W DUNLAP AVE STE 140
PHOENIX
AZ
850215818
Practice Location Phone/Fax
| Phone: | 6022795351 |
| Fax: | 6022795361 |
Provider Mailing Location
4041 N CENTRAL AVE BLDG C
PHOENIX
AZ
850123313
Provider Mailing Phone/Fax
| Phone: | 6022795262 |
| Fax: | 6022795390 |