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General NPI Number Information
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NPI Number | 1407158215
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Entity Type | Organization
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Legal Business Name | BANWOL
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 3407 LANCASTER PIKE
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City | WILMINGTON
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State | DE
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Zip | 19805-5543
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Country | US
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Telephone | 302-998-9880
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Fax |
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Provider Business Mailing Address
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Address Line | 3407 LANCASTER PIKE
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City | WILMINGTON
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State | DE
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Zip | 19805-5543
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Country | US
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Telephone | 302-998-9880
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MURIEL LARAMORE
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Credential | MHS
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Telephone | 267-304-1649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | DE
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