Healthcare Provider Details

I. General information

NPI: 1043081029
Provider Name (Legal Business Name): MINDFUL CONCEPTS THERAPEUTIC AND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 HIGHLAND CIR
NEWARK DE
19713-1458
US

IV. Provider business mailing address

88 HIGHLAND CIR
NEWARK DE
19713-1458
US

V. Phone/Fax

Practice location:
  • Phone: 215-880-2949
  • Fax:
Mailing address:
  • Phone: 215-880-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BLASSINGALE COREY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPCMH
Phone: 215-880-2949