Provider Demographics
NPI:1801361977
Name:A CENTER FOR MENTAL WELLNESS COMMUNITY SUPPORT PROGRAMS, LLC
Entity Type:Organization
Organization Name:A CENTER FOR MENTAL WELLNESS COMMUNITY SUPPORT PROGRAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-674-1397
Mailing Address - Street 1:25 S. OLD BALTIMORE PIKE
Mailing Address - Street 2:LAFAYETTE BUILDING 1, SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-266-6200
Mailing Address - Fax:302-266-6212
Practice Address - Street 1:25 S. OLD BALTIMORE PIKE
Practice Address - Street 2:LAFAYETTE BUILDING 1, SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:022-666-2003
Practice Address - Fax:302-266-6212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A CENTER FOR MENTAL WELLNESS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1639325822OtherDSCYF