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General NPI Number Information
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NPI Number | 1538626239
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Entity Type | Organization
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Legal Business Name | ACTUALIZED HOLISTIC WELLNESS, LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 504 N DUPONT HWY
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City | DOVER
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State | DE
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Zip | 19901-3961
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Country | US
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Telephone | 302-566-7245
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Fax | 302-336-9957
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Provider Business Mailing Address
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Address Line | 504 N DUPONT HWY
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City | DOVER
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State | DE
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Zip | 19901-3961
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Country | US
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Telephone | 302-566-7245
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Fax | 302-336-9957
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER PATRICE EDWARDS
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Credential | PH.D., LPCMH
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Telephone | 302-566-7245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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