Healthcare Provider Details

I. General information

NPI: 1922876358
Provider Name (Legal Business Name): TAKEYA NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LANCASTER PIKE STE 305
WILMINGTON DE
19805-1511
US

IV. Provider business mailing address

2616 ZEBLEY PL
WILMINGTON DE
19802-3479
US

V. Phone/Fax

Practice location:
  • Phone: 302-278-0026
  • Fax:
Mailing address:
  • Phone: 302-332-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1632095
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1632095
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1632095
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: