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614 Black Gates Rd Wilmington DE 19803-2240 | |
| (302) 530-9520 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 614 Black Gates Rd, Wilmington, Delaware |
| Authorized Official Name and Position | Beth B Donovan (OWNER) |
| Authorized Official Contact | 3025309520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1053 Country Club Rd West Chester PA 19382-8060 Ph: (302) 530-9520 | 614 Black Gates Rd Wilmington DE 19803-2240 Ph: (302) 530-9520 |
| NPI Number | 1023833100 |
|---|---|
| Provider Enumeration Date | 11/22/2024 |
| Last Update Date | 12/17/2024 |
| Certification Date | 12/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023833100 | NPI | - | NPPES |
| 250797368 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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