Individual
MRS. GWENDOLYN MARCELLA BLACKNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGADC
Contact information
Practice address
65 DUKE ST STE 203, PRINCE FREDERICK, MD 20678-6128
(443) 824-4818
Mailing address
65 DUKE ST, PRINCE FREDERICK, MD 20678-6128
(443) 404-5751
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LGA2466
MD
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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