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General NPI Number Information
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NPI Number | 1770148157
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Entity Type | Organization
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Legal Business Name | MOXIE LIVING COUNSELING & COACHING LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 256 CHAPMAN RD STE 203
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City | NEWARK
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State | DE
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Zip | 19702-5415
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Country | US
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Telephone | 302-365-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 667 CORSICA AVE
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City | BEAR
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State | DE
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Zip | 19701-2513
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Country | US
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Telephone | 302-365-5935
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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 | JENNELLE BIRTHWRIGHT
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Credential | LCSW
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Telephone | 302-365-5935
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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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