Healthcare Provider Details

I. General information

NPI: 1912434721
Provider Name (Legal Business Name): CAITLIN PEPPER LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 SWEEPING MIST CIR
FREDERICA DE
19946-2408
US

IV. Provider business mailing address

263 SWEEPING MIST CIR
FREDERICA DE
19946-2408
US

V. Phone/Fax

Practice location:
  • Phone: 302-222-1987
  • Fax:
Mailing address:
  • Phone: 302-222-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000789
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: