Provider Demographics
NPI:1720649783
Name:MCGILBERRY, TARIQ (CDAC)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:MCGILBERRY
Suffix:
Gender:M
Credentials:CDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103A ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5767
Mailing Address - Country:US
Mailing Address - Phone:302-470-1758
Mailing Address - Fax:
Practice Address - Street 1:103A ROGERS RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5767
Practice Address - Country:US
Practice Address - Phone:302-470-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1825101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)