Provider Demographics
NPI:1396059663
Name:NELSON-BLAKE, NATALIE (PHD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:NELSON-BLAKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4096 PIEDMONT AVE # 185
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5221
Mailing Address - Country:US
Mailing Address - Phone:510-982-1000
Mailing Address - Fax:
Practice Address - Street 1:5349 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1416
Practice Address - Country:US
Practice Address - Phone:510-982-1000
Practice Address - Fax:510-210-9310
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health