Healthcare Provider Details

I. General information

NPI: 1255193108
Provider Name (Legal Business Name): KENNESHA GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CHAPMAN RD STE 201
NEWARK DE
19702-5415
US

IV. Provider business mailing address

407 GALWAY CT
MIDDLETOWN DE
19709-8796
US

V. Phone/Fax

Practice location:
  • Phone: 302-292-1334
  • Fax:
Mailing address:
  • Phone: 302-563-3002
  • 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:
Title or Position:
Credential:
Phone: