MEDICARE: HENRY N COFFIELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	Q1-0001180	DE
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	Q1-0001180	DE
3	101YM0800X	Mental Health Counselor	Q1-0001180	DE
4	106H00000X	Marriage & Family Therapist	Q1-0001180	DE
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1447686423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY N COFFIELD

Provider Business Mailing Address
First Line	:	227 N VAN BUREN ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-3672
Country	:	US
Telephone Number	:	302-507-3532
Fax Number	:	302-691-8013

Provider Business Practice Location Address
First Line	:	227 N VAN BUREN ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-3672
Country	:	US
Telephone Number	:	302-507-3532
Fax Number	:	302-691-8013

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HENRY N COFFIELD
Credential	:	PMHNP-BC
Telephone Number	:	302-507-3532

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	11/03/2022

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