Provider Demographics
NPI:1386356640
Name:WAMBU, GRACE (LPC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WAMBU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 ROUTE 33 STE H
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1752
Mailing Address - Country:US
Mailing Address - Phone:609-930-7133
Mailing Address - Fax:
Practice Address - Street 1:2222 ROUTE 33 STE H
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1752
Practice Address - Country:US
Practice Address - Phone:609-930-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional