Provider Demographics
NPI:1083962146
Name:DELGADO, ENJOLE DIONNE (MACC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ENJOLE
Middle Name:DIONNE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MACC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 STRADA CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3201
Mailing Address - Country:US
Mailing Address - Phone:817-453-2400
Mailing Address - Fax:817-453-2414
Practice Address - Street 1:604 STRADA CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3201
Practice Address - Country:US
Practice Address - Phone:817-453-2400
Practice Address - Fax:817-453-2414
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69421101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083962146OtherFOCUS FOR LIVING