Healthcare Provider Details

I. General information

NPI: 1679461743
Provider Name (Legal Business Name): KELSEY MARIE HOJAN-CLARK LACMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 E MAIN ST
NEWARK DE
19711-7311
US

IV. Provider business mailing address

3510 KENNETT PIKE
WILMINGTON DE
19807-3029
US

V. Phone/Fax

Practice location:
  • Phone: 443-987-6557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0010484
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: