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General NPI Number Information
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NPI Number | 1720945785
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Entity Type | Organization
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Legal Business Name | AGEWISE DE LLC
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 2313 CONCORD PIKE
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City | WILMINGTON
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State | DE
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Zip | 19803-2911
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Country | US
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Telephone | 912-266-0289
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 N LINCOLN ST
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City | WILMINGTON
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State | DE
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Zip | 19806-2311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | LAURA DICKOL
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Credential | LCSW
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Telephone | 912-266-0289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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