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General NPI Number Information
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NPI Number | 1710617931
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Entity Type | Organization
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Legal Business Name | CREEKSIDE COUNSELING AND WELLNESS INC
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Dates
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Enumeration Date | 06/11/2022
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Last Update Date | 06/11/2022
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Provider Practice Location Address
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Address Line | 1601 CONCORD PIKE STE 54
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City | WILMINGTON
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State | DE
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Zip | 19803-3630
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Country | US
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Telephone | 302-562-7953
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Fax |
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Provider Business Mailing Address
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Address Line | 318 N DILLWYN RD
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City | NEWARK
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State | DE
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Zip | 19711-5505
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Country | US
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Telephone | 302-562-7953
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | GRETCHEN MAHONEY
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Credential | LCPC, LPCMH
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Telephone | 302-562-7953
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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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