Organization
GENESIS INTEGRATIVE MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE JACKSON FNP-C, PMHNP-BC (MANAGER/EMPLOYEE)
(302) 232-6172
Entity
Organization
Contact information
Practice address
8 THE GRN STE A, DOVER, DE 19901-3618
(302) 232-6172
(628) 300-2429
Mailing address
8 THE GRN STE A, DOVER, DE 19901-3618
(302) 232-6172
(628) 300-2429
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/28/2023
Last updated
12/28/2023
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