Healthcare Provider Details

I. General information

NPI: 1770148157
Provider Name (Legal Business Name): MOXIE LIVING COUNSELING & COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CHAPMAN RD STE 203
NEWARK DE
19702-5415
US

IV. Provider business mailing address

667 CORSICA AVE
BEAR DE
19701-2513
US

V. Phone/Fax

Practice location:
  • Phone: 302-365-5935
  • Fax:
Mailing address:
  • Phone: 302-365-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNELLE BIRTHWRIGHT
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 302-365-5935