Healthcare Provider Details

I. General information

NPI: 1285049908
Provider Name (Legal Business Name): FELICIA CONNOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BLEVINS DR SUITE 5
NEW CASTLE DE
19720-4177
US

IV. Provider business mailing address

PO BOX 536
HOCKESSIN DE
19707-0536
US

V. Phone/Fax

Practice location:
  • Phone: 302-635-7087
  • Fax:
Mailing address:
  • Phone: 302-635-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberB1-0000959
License Number StateDE

VIII. Authorized Official

Name: FELICIA CONNOR
Title or Position: OWNER
Credential: CP
Phone: 302-635-7087