Healthcare Provider Details

I. General information

NPI: 1104130657
Provider Name (Legal Business Name): BRAIN WORKS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20155 OFFICE CIRCLE, SUITE 2 GEORGETOWN PROFESSIONAL PARK
GEORGETOWN DE
19947
US

IV. Provider business mailing address

PO BOX 518
GEORGETOWN DE
19947-0518
US

V. Phone/Fax

Practice location:
  • Phone: 302-396-1588
  • Fax: 302-396-0409
Mailing address:
  • Phone: 302-396-1588
  • Fax: 302-396-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number20100629122
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20100629122
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number20100629122
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20100629122
License Number StateDE

VIII. Authorized Official

Name: DR. ALTON EDWARD JOSEPH
Title or Position: PRESIDENT/CEO
Credential: PH.D.
Phone: 302-396-1588