Individual
GWENDOLYN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ED.S., LPC
Contact information
Practice address
65 OLD RT. 22, SUITE 7B, CLINTON, NJ 08809
(908) 386-2897
Mailing address
285 HILLCREST DR, MILFORD, NJ 08848-1003
(908) 892-0005
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37PC00540100
NJ
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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