Provider Demographics
NPI:1568979615
Name:DENNIS, SHELATIA JAYUNE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELATIA
Middle Name:JAYUNE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 NATHANIEL MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7011
Mailing Address - Country:US
Mailing Address - Phone:302-465-0630
Mailing Address - Fax:
Practice Address - Street 1:9 E LOOCKERMAN ST STE 302
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-8305
Practice Address - Country:US
Practice Address - Phone:302-465-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0001375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker