Healthcare Provider Details

I. General information

NPI: 1487778247
Provider Name (Legal Business Name): SELF REALIZATION CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 LILAC DR
MIDDLETOWN DE
19709-8639
US

IV. Provider business mailing address

507 LILAC DR
MIDDLETOWN DE
19709-8639
US

V. Phone/Fax

Practice location:
  • Phone: 302-312-8221
  • Fax: 302-378-9128
Mailing address:
  • Phone: 302-312-8221
  • Fax: 302-378-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0000757
License Number StateDE

VIII. Authorized Official

Name: DR. EARL EUGENE WALKER JR.
Title or Position: OWNER, PRESIDENT
Credential: ED.D.
Phone: 302-312-8221