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2400 W 4th St Wilmington DE 19805-3306 | |
| (302) 645-1816 | |
| (302) 654-4130 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2400 W 4th St, Wilmington, Delaware |
| Authorized Official Name and Position | Teresa Jackson (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6103631488 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
467 Creamery Way Exton PA 19341-2508 Ph: (610) 363-1488 | 2400 W 4th St Wilmington DE 19805-3306 Ph: (302) 645-1816 |
| NPI Number | 1699081950 |
|---|---|
| Provider Enumeration Date | 08/25/2010 |
| Last Update Date | 09/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699081950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (Delaware) | Primary |
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