Healthcare Provider Details

I. General information

NPI: 1790847515
Provider Name (Legal Business Name): EBONY T MADDREY M.S., LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

IV. Provider business mailing address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

V. Phone/Fax

Practice location:
  • Phone: 302-981-4466
  • Fax:
Mailing address:
  • Phone: 302-501-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ3-0000249
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0011145
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: