Provider Demographics
NPI:1578616488
Name:OBENSHAIN, DORIS VENETTA (MS, NCC, CADC, LPCMH)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:VENETTA
Last Name:OBENSHAIN
Suffix:
Gender:F
Credentials:MS, NCC, CADC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CECILTON
Mailing Address - State:MD
Mailing Address - Zip Code:21913-0577
Mailing Address - Country:US
Mailing Address - Phone:410-275-8094
Mailing Address - Fax:
Practice Address - Street 1:525 POLLY DRUMMOND HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4342
Practice Address - Country:US
Practice Address - Phone:302-448-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
DEPC0000442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral