Provider Demographics
NPI:1629743208
Name:MASON, ELYSHA (NCC)
Entity Type:Individual
Prefix:
First Name:ELYSHA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LAVERTY LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-1335
Mailing Address - Country:US
Mailing Address - Phone:302-258-5388
Mailing Address - Fax:
Practice Address - Street 1:1310 BRIDGEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1617
Practice Address - Country:US
Practice Address - Phone:302-515-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health