Provider Demographics
NPI:1700547650
Name:THE DELAWARE CENTER FOR MINDFULNESS, LLC
Entity Type:Organization
Organization Name:THE DELAWARE CENTER FOR MINDFULNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-803-0119
Mailing Address - Street 1:425 FINGERBOARD SCHOOLHOUS RD
Mailing Address - Street 2:
Mailing Address - City:EARLEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21919-1420
Mailing Address - Country:US
Mailing Address - Phone:302-307-1779
Mailing Address - Fax:
Practice Address - Street 1:2607 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2922
Practice Address - Country:US
Practice Address - Phone:302-307-1779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty