Healthcare Provider Details

I. General information

NPI: 1053952598
Provider Name (Legal Business Name): ATLANTIC RECOVERY INSTITUTE AND ADVOCACY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S DELAWARE ST
SMYRNA DE
19977-1447
US

IV. Provider business mailing address

110 S DELAWARE ST
SMYRNA DE
19977-1447
US

V. Phone/Fax

Practice location:
  • Phone: 302-632-2204
  • Fax:
Mailing address:
  • Phone: 302-632-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA FRITZGES
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 302-632-2204