Organization
MID-ATLANTIC BEHAVIORAL HEALTH, LLC
Active
Other names
LifeStance Health
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PARDO (CHIEF LEGAL OFFICER)
(206) 399-1493
Entity
Organization
Contact information
Practice address
910 S CHAPEL ST, SUITE 102, NEWARK, DE 19713-3467
(302) 224-1400
(302) 224-1402
Mailing address
910 S CHAPEL ST, SUITE 102, NEWARK, DE 19713-3467
(302) 224-1400
(302) 224-1402
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
04/18/2007
Last updated
01/02/2024
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