Individual
KIMBERLEY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, NCC, LPC
Contact information
Practice address
140 JOHN ST, BRIDGEPORT, CT 06604-4323
(203) 450-9944
Mailing address
140 JOHN ST, BRIDGEPORT, CT 06604-4323
(203) 450-9944
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
004945
CT
Other
Enumeration date
07/28/2021
Last updated
07/28/2021
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