Healthcare Provider Details

I. General information

NPI: 1497802540
Provider Name (Legal Business Name): SUZANNE LEE CHAFIN LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S QUEEN ST
DOVER DE
19904-3567
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7834
  • Fax: 302-734-7847
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000242
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: