Provider Demographics
NPI:1720132798
Name:ADVANCE COUNSELING
Entity Type:Organization
Organization Name:ADVANCE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-424-1322
Mailing Address - Street 1:115 N WALNUT STREET
Mailing Address - Street 2:ADVANCE COUNSELING
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-424-8000
Mailing Address - Fax:302-424-7772
Practice Address - Street 1:115 N WALNUT STREET
Practice Address - Street 2:ADVANCE COUNSELING
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-424-8000
Practice Address - Fax:302-424-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1999200113261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00044Medicare ID - Type Unspecified