Basic Information
| Provider Information | |||||||||
| NPI: | 1699145854 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL EDGE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1198 S GOVERNORS AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199046930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023828698 | ||||||||
| FaxNumber: | 3022693800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1198 S GOVERNORS AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199046930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023828698 | ||||||||
| FaxNumber: | 3022693800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | VANDER VEN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3023828698 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | L.P.C.M.H. | ||||||||
| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.