Healthcare Provider Details

I. General information

NPI: 1972380848
Provider Name (Legal Business Name): ELIZABETH JEANETTE WEALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COMMERCE DR STE 300
NEWARK DE
19713-2878
US

IV. Provider business mailing address

136 LAKS DR
MIDDLETOWN DE
19709-9390
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPP-000073891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: