Provider Demographics
NPI:1346396439
Name:DELMARVA FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:DELMARVA FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYNN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-944-0401
Mailing Address - Street 1:929 EASTERN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6461
Mailing Address - Country:US
Mailing Address - Phone:443-944-0401
Mailing Address - Fax:
Practice Address - Street 1:929 EASTERN SHORE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6461
Practice Address - Country:US
Practice Address - Phone:443-944-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD80005309Medicare ID - Type UnspecifiedSOCIAL WORK