Healthcare Provider Details

I. General information

NPI: 1649763434
Provider Name (Legal Business Name): CASSAUNDRA SOUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 E MASTEN CIR STE 113
MILFORD DE
19963-1268
US

IV. Provider business mailing address

769 E MASTEN CIR STE 113
MILFORD DE
19963-1268
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: