Healthcare Provider Details

I. General information

NPI: 1750126116
Provider Name (Legal Business Name): MEGHAN FICKES LACMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LIMESTONE RD STE 307
WILMINGTON DE
19808-1956
US

IV. Provider business mailing address

4420 LIMESTONE RD STE 307
WILMINGTON DE
19808-1956
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC-0010453
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: