Healthcare Provider Details

I. General information

NPI: 1275622839
Provider Name (Legal Business Name): ASSOCIATES IN HEALTH PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CONCORD PIKE SUITE 103
WILMINGTON DE
19803-3642
US

IV. Provider business mailing address

1521 CONCORD PIKE SUITE 103
WILMINGTON DE
19803-3642
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-0205
  • Fax: 302-428-1123
Mailing address:
  • Phone: 302-428-0205
  • Fax: 302-428-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1989028825
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1989028825
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1989028825
License Number StateDE

VIII. Authorized Official

Name: SHARON B JACOBS
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 302-428-0205