Healthcare Provider Details

I. General information

NPI: 1588273239
Provider Name (Legal Business Name): EMBODIED COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PHILADELPHIA PIKE
WILMINGTON DE
19809-2280
US

IV. Provider business mailing address

900 PHILADELPHIA PIKE
WILMINGTON DE
19809-2280
US

V. Phone/Fax

Practice location:
  • Phone: 302-797-1233
  • Fax:
Mailing address:
  • Phone: 302-797-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CASEY PAULINE OBSTFELD
Title or Position: OWNER
Credential: LPCMH
Phone: 302-256-0170