Healthcare Provider Details

I. General information

NPI: 1689345449
Provider Name (Legal Business Name): KEITH L BELVIN MHSC, MS ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 HIGH ST
SEAFORD DE
19973-3923
US

IV. Provider business mailing address

1041 N DUPONT HWY # 1276
DOVER DE
19901-2006
US

V. Phone/Fax

Practice location:
  • Phone: 302-394-6051
  • Fax: 302-485-5887
Mailing address:
  • Phone: 302-314-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: