Healthcare Provider Details

I. General information

NPI: 1710685862
Provider Name (Legal Business Name): SUSAN NTEGE NAKAWEESA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 PASSMORE RD
WILMINGTON DE
19803-1548
US

IV. Provider business mailing address

235 N ANTLERS PL
BEAR DE
19701-2779
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-9411
  • Fax:
Mailing address:
  • Phone: 302-650-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0011355
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: