Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 429 | DE |
NPI | 1003105339 |
---|---|
Provider Name | Mary C. Fenimore |
First Address | Dover, DE 19904-7348 |
Second Address | Middletown, DE 19709-5863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 14/04/2018 |