Provider Demographics
NPI:1336686344
Name:OWENS-WILMOTH, BRENDA JANICE (LMSW ICAADC SAP-DOT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANICE
Last Name:OWENS-WILMOTH
Suffix:
Gender:F
Credentials:LMSW ICAADC SAP-DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 CONCORD PIKE STE 1073
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5022
Mailing Address - Country:US
Mailing Address - Phone:302-438-2581
Mailing Address - Fax:
Practice Address - Street 1:3640 CONCORD PIKE STE 1073
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5022
Practice Address - Country:US
Practice Address - Phone:302-438-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE806054101YA0400X
DEQ3-0000097104100000X
DE1665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker