Individual
GINA G STOUTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1500 ROUTE 88, BRICK, NJ 08724-2320
(732) 785-1900
Mailing address
PO BOX 2036, LAKEWOOD, NJ 08701-8036
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00411300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
07/19/2018
Last updated
07/19/2018
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