Healthcare Provider Details

I. General information

NPI: 1346320983
Provider Name (Legal Business Name): BRANDYWINE COUNSELING & COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date: 08/30/2022
Reactivation Date: 09/27/2022

III. Provider practice location address

2713 LANCASTER AVE
WILMINGTON DE
19805-5220
US

IV. Provider business mailing address

2713 LANCASTER AVE
WILMINGTON DE
19805-5220
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-9267
  • Fax: 302-655-8920
Mailing address:
  • Phone: 302-225-9267
  • Fax: 302-655-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN M FAHEY
Title or Position: CEO
Credential: PHD
Phone: 302-225-9269