Provider Demographics
NPI:1386875029
Name:GONTANG, FELICITAS O (LCSW,ICADC,ICCDPD)
Entity type:Individual
Prefix:
First Name:FELICITAS
Middle Name:O
Last Name:GONTANG
Suffix:
Gender:F
Credentials:LCSW,ICADC,ICCDPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 S BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1852
Mailing Address - Country:US
Mailing Address - Phone:302-856-5490
Mailing Address - Fax:302-856-5094
Practice Address - Street 1:546 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1852
Practice Address - Country:US
Practice Address - Phone:302-856-5490
Practice Address - Fax:302-856-5094
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical