Provider Demographics
NPI:1770283152
Name:GWEN BLAKE COUNSELING, LLC
Entity type:Organization
Organization Name:GWEN BLAKE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-892-0005
Mailing Address - Street 1:GWEN BLAKE
Mailing Address - Street 2:285 HILLCREST DRIVE
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848
Mailing Address - Country:US
Mailing Address - Phone:908-892-0005
Mailing Address - Fax:
Practice Address - Street 1:27 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1340
Practice Address - Country:US
Practice Address - Phone:908-892-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty