Healthcare Provider Details

I. General information

NPI: 1942350145
Provider Name (Legal Business Name): COUNSELING RESOURCE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 LARKSPUR RD
NEWARK DE
19711-6863
US

IV. Provider business mailing address

117 LARKSPUR RD
NEWARK DE
19711-6863
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-9963
  • Fax: 302-995-2121
Mailing address:
  • Phone: 302-738-9963
  • Fax: 302-995-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number20547
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number122
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000008
License Number StateDE

VIII. Authorized Official

Name: J. ROY CANNON
Title or Position: CHIEF OPERATING OFFICER
Credential: LPCMH
Phone: 302-738-9963