Healthcare Provider Details

I. General information

NPI: 1053470260
Provider Name (Legal Business Name): CONNECTIONS CSP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 BLACKBIRD LANDING RD
TOWNSEND DE
19734-9141
US

IV. Provider business mailing address

3821 LANCASTER PIKE
WILMINGTON DE
19805-1512
US

V. Phone/Fax

Practice location:
  • Phone: 302-659-0512
  • Fax: 302-659-3949
Mailing address:
  • Phone: 302-442-6622
  • Fax: 302-984-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1518
License Number StateDE

VIII. Authorized Official

Name: JEVON Z HICKS
Title or Position: DIRECTOR
Credential:
Phone: 302-377-2358