Healthcare Provider Details

I. General information

NPI: 1548664295
Provider Name (Legal Business Name): CENTER FOR CONSCIOUS HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 CARTER DR SUITE B
MIDDLETOWN DE
19709-5846
US

IV. Provider business mailing address

819 KINGSWOOD PATH
MIDDLETOWN DE
19709-7523
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-6144
  • Fax:
Mailing address:
  • Phone: 612-916-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. COLLEEN M MCGINNIS
Title or Position: OWNER
Credential: PSYD
Phone: 612-916-0207