Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CD-0000009 | DE |
Y | 101YM0800X | Mental Health Counselor | PC-0000266 | DE |
NPI | 1013059377 |
---|---|
Provider Name | Cathy Teoli-Lavallee |
First Address | Newark, DE 19711-2036 |
Second Address | Newark, DE 19702-5707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 09/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000022913 | (05) | DE |