Healthcare Provider Details

I. General information

NPI: 1578809414
Provider Name (Legal Business Name): DAPHNE CARROLL LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 PHILADELPHIA PIKE
WILMINGTON DE
19809-2177
US

IV. Provider business mailing address

20 SHERBROOKE DR
WILMINGTON DE
19808-2334
US

V. Phone/Fax

Practice location:
  • Phone: 302-762-8989
  • Fax:
Mailing address:
  • Phone: 302-994-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-0000461
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: