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General NPI Number Information
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NPI Number | 1194364141
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Entity Type | Organization
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Legal Business Name | HEALING SOURCE LLC
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Dates
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Enumeration Date | 12/21/2019
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 153 E CHESTNUT HILL RD STE 209
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City | NEWARK
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State | DE
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Zip | 19713-4047
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Country | US
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Telephone | 302-509-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 490 STAMFORD DR APT 111
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City | NEWARK
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State | DE
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Zip | 19711-2789
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Country | US
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Telephone | 302-981-2701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JODI WILLEMS
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Credential |
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Telephone | 302-981-2701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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