=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932879343
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI WARDWELL LMHCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2021
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 NAAMANS RD STE 110
-----------------------------------------------------
City | CLAYMONT
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19703-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-224-1400
-----------------------------------------------------
Fax | 302-224-1402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 NAAMANS RD STE 110
-----------------------------------------------------
City | CLAYMONT
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19703-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-339-3991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | AC-0010348
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------