Provider Demographics
NPI:1811647837
Name:DESSELLE, FALON
Entity type:Individual
Prefix:
First Name:FALON
Middle Name:
Last Name:DESSELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 NEW LINDEN HILL RD
Mailing Address - Street 2:SUITE #152
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-683-1055
Mailing Address - Fax:
Practice Address - Street 1:4550 NEW LINDEN HILL RD
Practice Address - Street 2:152
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1980
Practice Address - Country:US
Practice Address - Phone:302-683-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0012010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical