Healthcare Provider Details

I. General information

NPI: 1629885777
Provider Name (Legal Business Name): ERIN O'BRIEN, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SHALLCROSS AVE STE 1A-3
WILMINGTON DE
19806-3037
US

IV. Provider business mailing address

1612 WOODLAWN AVE
WILMINGTON DE
19806-2452
US

V. Phone/Fax

Practice location:
  • Phone: 856-981-7015
  • Fax:
Mailing address:
  • Phone: 856-981-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIN KATHERINE O'BRIEN
Title or Position: OWNER
Credential: MA, LPC, LPCMH
Phone: 856-981-7015