Provider Demographics
NPI:1316312754
Name:WELLSPRING EMOTIONAL HEALTH, LLC
Entity type:Organization
Organization Name:WELLSPRING EMOTIONAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENROD WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-377-8341
Mailing Address - Street 1:900 FOULK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-377-8341
Mailing Address - Fax:866-277-1795
Practice Address - Street 1:900 FOULK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-377-8341
Practice Address - Fax:866-277-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00006801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty