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General NPI Number Information
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NPI Number | 1487225462
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Entity Type | Organization
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Legal Business Name | RIVER BANK OPTIMAL WELLNESS CONNECTION, INC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 7209 LANCASTER PIKE
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City | HOCKESSIN
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State | DE
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Zip | 19707-9292
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Country | US
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Telephone | 302-442-5172
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Fax | 949-561-5360
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Provider Business Mailing Address
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Address Line | 7209 LANCASTER PIKE STE 4-1153
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City | HOCKESSIN
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State | DE
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Zip | 19707-9292
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Country | US
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Telephone | 302-442-5172
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Fax | 949-561-5360
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA PORE'E
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Credential | LPC
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Telephone | 302-442-5172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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