Provider Demographics
NPI:1053448803
Name:DISCOVERING YOUR HIDDEN VALUES
Entity type:Organization
Organization Name:DISCOVERING YOUR HIDDEN VALUES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONEAK
Authorized Official - Middle Name:C
Authorized Official - Last Name:BASKERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPMHC, NCC, MS
Authorized Official - Phone:302-740-0746
Mailing Address - Street 1:3 N REDSPIRE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3947
Mailing Address - Country:US
Mailing Address - Phone:302-834-5242
Mailing Address - Fax:302-834-7532
Practice Address - Street 1:200 S DUPONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3972
Practice Address - Country:US
Practice Address - Phone:302-429-4118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ37PC00337200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250552890Medicaid
NJ0097250Medicaid