Provider Demographics
NPI:1437847779
Name:BASKERVILLE, VASHTI (MS)
Entity Type:Individual
Prefix:
First Name:VASHTI
Middle Name:
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 N REDSPIRE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3947
Mailing Address - Country:US
Mailing Address - Phone:302-220-3270
Mailing Address - Fax:
Practice Address - Street 1:222 PHILADELPHIA PIKE STE 12
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3166
Practice Address - Country:US
Practice Address - Phone:302-384-7981
Practice Address - Fax:302-482-3008
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty