Healthcare Provider Details

I. General information

NPI: 1437623956
Provider Name (Legal Business Name): STACEY EDNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 E MASTEN CIR
MILFORD DE
19963-1091
US

IV. Provider business mailing address

769 E MASTEN CIR
MILFORD DE
19963-1091
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-4700
  • Fax:
Mailing address:
  • Phone: 302-856-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC-0000130
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: