Provider Demographics
NPI:1831410711
Name:BURRITT, THERESA M (LPCMH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:BURRITT
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:B
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCMH
Mailing Address - Street 1:156 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7314
Mailing Address - Country:US
Mailing Address - Phone:302-674-2380
Mailing Address - Fax:302-674-1299
Practice Address - Street 1:156 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7314
Practice Address - Country:US
Practice Address - Phone:302-674-2380
Practice Address - Fax:302-674-1299
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPC-0000405OtherSTATE OF DELAWARE