Provider Demographics
NPI: | 1740804038 |
---|---|
Name: | DEBORAH STOKES, PHD, LLC |
Entity type: | Organization |
Organization Name: | DEBORAH STOKES, PHD, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DEBORAH |
Authorized Official - Middle Name: | ANNE |
Authorized Official - Last Name: | STOKES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 703-380-4173 |
Mailing Address - Street 1: | 130 MANILA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LEWES |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19958-1722 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-380-4173 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 414 E SAVANNAH RD |
Practice Address - Street 2: | |
Practice Address - City: | LEWES |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19958-1133 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-200-3741 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-06-02 |
Last Update Date: | 2020-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
14647435 | Other | CAQH |