Provider Demographics
NPI:1003540212
Name:BLOUNT, JOYA ALANNIE (LAC)
Entity Type:Individual
Prefix:
First Name:JOYA
Middle Name:ALANNIE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 BELLEVUE AVE APT 67
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1838
Mailing Address - Country:US
Mailing Address - Phone:609-707-3301
Mailing Address - Fax:
Practice Address - Street 1:409 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1633
Practice Address - Country:US
Practice Address - Phone:856-589-3420
Practice Address - Fax:856-345-2820
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00653000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00653000OtherLICENSED ASSOCIATE COUNSELOR