Healthcare Provider Details

I. General information

NPI: 1194211326
Provider Name (Legal Business Name): NINEKA DYSON LPCMH, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PHILADELPHIA PIKE STE 4
WILMINGTON DE
19809-3166
US

IV. Provider business mailing address

PO BOX 8075
WILMINGTON DE
19803-8075
US

V. Phone/Fax

Practice location:
  • Phone: 404-272-5488
  • Fax:
Mailing address:
  • Phone: 302-932-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000902
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: