1811205909 NPI number — MRS. MALIKA DIONNE MCMEANS SPRUILL LCSW

Table of content: MRS. MALIKA DIONNE MCMEANS SPRUILL LCSW (NPI 1811205909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811205909 NPI number — MRS. MALIKA DIONNE MCMEANS SPRUILL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMEANS SPRUILL
Provider First Name:
MALIKA
Provider Middle Name:
DIONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811205909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 SWEET HOLLOW WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-8652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-377-5883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 VANDYKE GREENSPRING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWNSEND
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19734-9218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-312-7072
Provider Business Practice Location Address Fax Number:
833-303-0292
Provider Enumeration Date:
09/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  Q1-0001021 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 620958001 . This is a "MEDICARE DCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100059400035 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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