Healthcare Provider Details

I. General information

NPI: 1659870400
Provider Name (Legal Business Name): MISS ALEXIS SYLVIATTE CROWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 WALKER RD STE B
DOVER DE
19904-2758
US

IV. Provider business mailing address

10900 COLONIAL CT
LINCOLN DE
19960-4066
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-7015
  • Fax:
Mailing address:
  • Phone: 302-249-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: