Healthcare Provider Details

I. General information

NPI: 1831805597
Provider Name (Legal Business Name): PRIDE HEALTH CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MERRIMAC AVE
MIDDLETOWN DE
19709-4633
US

IV. Provider business mailing address

104 MERRIMAC AVE
MIDDLETOWN DE
19709-4633
US

V. Phone/Fax

Practice location:
  • Phone: 302-502-6084
  • Fax:
Mailing address:
  • Phone: 302-502-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE COPEMAN
Title or Position: OWNER
Credential: RN
Phone: 302-502-6084