Provider Demographics
NPI:1982070967
Name:HYNSON, DEVON SR
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:HYNSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W 4TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3367
Mailing Address - Country:US
Mailing Address - Phone:302-656-1090
Mailing Address - Fax:
Practice Address - Street 1:2500 W 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3367
Practice Address - Country:US
Practice Address - Phone:302-656-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE463089081103K00000X, 103TP2701X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator