Healthcare Provider Details

I. General information

NPI: 1679120406
Provider Name (Legal Business Name): AIMEE KATHERINE SELLERS LACMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AIMEE KATHERINE GRADY

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 POLLY DRUMMOND HILL RD
NEWARK DE
19711-5703
US

IV. Provider business mailing address

8 POLLY DRUMMOND HILL RD
NEWARK DE
19711-5703
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-6859
  • Fax: 302-368-5309
Mailing address:
  • Phone: 302-738-6859
  • Fax: 302-368-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0000279
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: