Healthcare Provider Details

I. General information

NPI: 1134773930
Provider Name (Legal Business Name): ANGELA DENISE GIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 OLD LANDING RD
MILLSBORO DE
19966-1210
US

IV. Provider business mailing address

1114 SOUTH DUPONT HIGHWAY STE 105 ATTN: JANINE COLEMAN
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-1920
  • Fax: 302-947-4645
Mailing address:
  • Phone: 302-442-6194
  • Fax: 302-672-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1615
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: