Individual
MARK J MAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2814 W 2ND ST, WILMINGTON, DE 19805-1807
(302) 472-0381
(302) 472-0392
Mailing address
2814 W 2ND ST, WILMINGTON, DE 19805-1807
(302) 472-0381
(302) 472-0392
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000034998
—
DE
Enumeration date
01/15/2007
Last updated
07/08/2007
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