Individual
BLONDENE PATRICE GOULBOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1053 OVERLOOK TER, UNION, NJ 07083-3607
(718) 208-3959
Mailing address
58 GARIBALDI AVE, LODI, NJ 07644-1806
(718) 208-3959
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00767200
NJ
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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