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General NPI Number Information
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NPI Number | 1346396439
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Entity Type | Organization
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Legal Business Name | DELMARVA FAMILY COUNSELING CENTER
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 929 EASTERN SHORE DR
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City | SALISBURY
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State | MD
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Zip | 21804-6461
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Country | US
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Telephone | 443-944-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 929 EASTERN SHORE DR
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City | SALISBURY
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State | MD
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Zip | 21804-6461
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Country | US
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Telephone | 443-944-0401
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Fax |
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Authorized Official
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Title or Position | THERPIST
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Name | DR. JACQUELYNN C. LUCK
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Credential | LCSWC
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Telephone | 443-944-0401
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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 | 06132
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License Number State | MD
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