Provider Demographics
NPI:1710617931
Name:CREEKSIDE COUNSELING AND WELLNESS INC
Entity Type:Organization
Organization Name:CREEKSIDE COUNSELING AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPCMH
Authorized Official - Phone:302-562-7953
Mailing Address - Street 1:318 N DILLWYN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5505
Mailing Address - Country:US
Mailing Address - Phone:302-562-7953
Mailing Address - Fax:
Practice Address - Street 1:1601 CONCORD PIKE STE 54
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3630
Practice Address - Country:US
Practice Address - Phone:302-562-7953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty