Healthcare Provider Details

I. General information

NPI: 1225596091
Provider Name (Legal Business Name): CASEY RENEE' WEST CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

IV. Provider business mailing address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax:
Mailing address:
  • Phone: 302-855-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1611
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: