Healthcare Provider Details

I. General information

NPI: 1134428295
Provider Name (Legal Business Name): FAMILY COUNSELING CENTER OF ST. PAUL'S, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N VAN BUREN ST
WILMINGTON DE
19805-3615
US

IV. Provider business mailing address

PO BOX 3803
WILMINGTON DE
19807-0803
US

V. Phone/Fax

Practice location:
  • Phone: 302-576-4136
  • Fax: 302-502-0456
Mailing address:
  • Phone: 302-576-4136
  • Fax: 302-502-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number043427
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number043427
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number043427
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number043427
License Number StateDE

VIII. Authorized Official

Name: MARIE REDFIELD
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 302-576-4136