Provider Demographics
NPI:1679771737
Name:GAMON, BRONWYN BLAIR (MS LPC)
Entity type:Individual
Prefix:MS
First Name:BRONWYN
Middle Name:BLAIR
Last Name:GAMON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 BLADES AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-3101
Mailing Address - Country:US
Mailing Address - Phone:252-638-4033
Mailing Address - Fax:
Practice Address - Street 1:517 BLADES AVE
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3101
Practice Address - Country:US
Practice Address - Phone:252-638-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC7312101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health