Healthcare Provider Details

I. General information

NPI: 1700245925
Provider Name (Legal Business Name): DEBRA HUTZ LACMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OMEGA DR. PROFESSIONAL CENTER #J
NEWARK DE
19713
US

IV. Provider business mailing address

1521 CONCORD PIKE SUITE 103
WILMINGTON DE
19803-3642
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-0205
  • Fax:
Mailing address:
  • Phone: 302-428-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0000105
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: