| Healing Source Llc | |
|
153 E Chestnut Hill Rd Ste 209 Newark DE 19713-4047 | |
| (302) 509-5888 | |
| Not Available |
| Full Name | Healing Source Llc |
|---|---|
| Speciality | Counselor |
| Location | 153 E Chestnut Hill Rd Ste 209, Newark, Delaware |
| Authorized Official Name and Position | Jodi Willems (OWNER) |
| Authorized Official Contact | 3029812701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Source Llc 490 Stamford Dr Apt 111 Newark DE 19711-2789 Ph: (302) 981-2701 | Healing Source Llc 153 E Chestnut Hill Rd Ste 209 Newark DE 19713-4047 Ph: (302) 509-5888 |
| NPI Number | 1194364141 |
|---|---|
| Provider Enumeration Date | 12/21/2019 |
| Last Update Date | 07/11/2023 |
| Certification Date | 07/11/2023 |
| Medicare PECOS PAC ID | 9335688506 |
|---|---|
| Medicare Enrollment ID | O20240902000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194364141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jodi Willems |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841733136 PECOS PAC ID: 0244779411 Enrollment ID: I20240902000383 |
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