Healthcare Provider Details

I. General information

NPI: 1760808794
Provider Name (Legal Business Name): JESSICA ESTOK LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 KIRKWOOD HWY
WILMINGTON DE
19805-2121
US

IV. Provider business mailing address

1305 KIRKWOOD HWY
WILMINGTON DE
19805-2121
US

V. Phone/Fax

Practice location:
  • Phone: 302-440-6737
  • Fax:
Mailing address:
  • Phone: 302-440-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCD-0000059
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: