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General NPI Number Information
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NPI Number | 1437957347
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Entity Type | Organization
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Legal Business Name | MINDCRAFT CONCIERGE SERVICES LLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1207 DELAWARE AVE # 918
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City | WILMINGTON
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State | DE
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Zip | 19806-4743
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Country | US
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Telephone | 302-603-1005
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Fax | 302-546-5700
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Provider Business Mailing Address
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Address Line | 1207 DELAWARE AVE # 918
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City | WILMINGTON
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State | DE
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Zip | 19806-4743
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Country | US
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Telephone | 302-603-1005
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Fax | 302-546-5700
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUDREY EVE LONGSON
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Credential | DO
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Telephone | 302-603-1005
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #5
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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Taxonomy #7
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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Taxonomy #8
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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