Healthcare Provider Details

I. General information

NPI: 1760854590
Provider Name (Legal Business Name): DIAMOND STATE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 KIRKWOOD HIGHWAY SUITE 250
NEWARK DE
19711
US

IV. Provider business mailing address

2644 KIRKWOOD HIGHWAY SUITE 250
NEWARK DE
19711
US

V. Phone/Fax

Practice location:
  • Phone: 302-683-1055
  • Fax: 302-683-1312
Mailing address:
  • Phone: 302-683-1055
  • Fax: 302-683-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC-000624
License Number StateDE

VIII. Authorized Official

Name: MRS. ELIZABETH M BOWMAN
Title or Position: CEO, PSYCHOTHERAPIST
Credential: LPCMH
Phone: 302-683-1055