=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730574146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART SONG COUNSELING & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2015
-----------------------------------------------------
Last Update Date | 04/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2644 CAPITOL TRL SUITE 330
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19711-7268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-593-4419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 OLDBURY DR
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LINDA LONERGAN
-----------------------------------------------------
Credential | LPCMH
-----------------------------------------------------
Telephone | 302-593-4419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PC0000699
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------