Healthcare Provider Details

I. General information

NPI: 1669028908
Provider Name (Legal Business Name): KEISHIA M. HEMPHILL LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 EBRIGHT RD
WILMINGTON DE
19810-1125
US

IV. Provider business mailing address

925 CLOISTER RD APT E
WILMINGTON DE
19809-1021
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000917
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: