Healthcare Provider Details

I. General information

NPI: 1689733792
Provider Name (Legal Business Name): CONNECTIONS COMMUNITY SUPPORT PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 LANCASTER PIKE
WILMINGTON DE
19805-1512
US

IV. Provider business mailing address

3821 LANCASTER PIKE
WILMINGTON DE
19805-1512
US

V. Phone/Fax

Practice location:
  • Phone: 302-230-9102
  • Fax: 302-984-3329
Mailing address:
  • Phone: 302-442-6622
  • Fax: 302-984-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEVON Z HICKS
Title or Position: DIRECTOR
Credential:
Phone: 302-377-2358