Healthcare Provider Details

I. General information

NPI: 1376670844
Provider Name (Legal Business Name): THE CLINICAL PASTORAL COUNSELING PROGRAM OF KENT AND SUSSEX COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PINE AND POPLAR STREE ST. JOHNS UNITED METHODIST CHURCH
SEAFORD DE
19973-0299
US

IV. Provider business mailing address

PO BOX 299
SEAFORD DE
19973-0299
US

V. Phone/Fax

Practice location:
  • Phone: 302-632-8842
  • Fax: 302-422-3360
Mailing address:
  • Phone: 302-632-8842
  • Fax: 302-422-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberPC-0000288
License Number StateDE

VIII. Authorized Official

Name: MR. DAINEL E COOPER
Title or Position: DIRECTOR
Credential: LPCMH
Phone: 302-632-8842