Healthcare Provider Details

I. General information

NPI: 1720564529
Provider Name (Legal Business Name): BETHANIE HAKES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 DELAWARE AVE
WILMINGTON DE
19806-4704
US

IV. Provider business mailing address

5641 DUPONT PKWY
SMYRNA DE
19977-9229
US

V. Phone/Fax

Practice location:
  • Phone: 302-468-4530
  • Fax:
Mailing address:
  • Phone: 302-359-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0010395
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: