Brandywine Counseling & Community Services, Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BRANDYWINE COUNSELING & COMMUNITY SERVICES, INC.

Practice address

2713 Lancaster Ave
Wilmington, DE 19805-5220

Phone

(302) 225-9267

Fax

(302) 655-8920

NPI assigned

Oct 17, 2006

Reactivated

Sep 27, 2022

Last updated

Sep 27, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lynn M Fahey, PHDNPI 1457402703

Title

Ceo

Phone

(302) 225-9269

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in DE

Opioid treatment program

Medicare-enrolled since Aug 14, 2020

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lynn M Fahey

  • Addiction (Substance Use Disorder) Counselor
  • Wilmington, DE
  • NPI 1457402703
  NPD Authorized official
• Harry G Burden

  • Peer Specialist
  • Newark, DE
  • NPI 1063176501
  NPD
• Renee Cumens, MMS, PA-C

  • Physician Assistant
  • Milford, DE
  • NPI 1215312848
  NPD
• Kelly Fox

  • Peer Specialist
  • Newark, DE
  • NPI 1891440855
  NPD
• Nicolle G Petticrew, B.A., CADC

  • Addiction (Substance Use Disorder) Counselor
  • Newark, DE
  • NPI 1306990379
  NPD
• Regina Thomas

  • Peer Specialist
  • Newark, DE
  • NPI 1740976562
  NPD
• Adar Wells

  • Addiction (Substance Use Disorder) Counselor
  • Wilmington, DE
  • NPI 1750018321
  NPD
• Khalil Abdar-Rashid

  • Addiction (Substance Use Disorder) Counselor
  • Milford, DE
  • NPI 1275026841
  NPD (past)
• Francesco Angelo Agresta

  • Addiction (Substance Use Disorder) Counselor
  • Georgetown, DE
  • NPI 1700052768
  NPD (past)
• Jennifer Balback, LPN

  • Licensed Practical Nurse
  • Newark, DE
  • NPI 1396114245
  NPD (past)
• Sue Ann Bardsley, APRN

  • Adult Psychiatric/Mental Health Registered Nurse
  • Georgetown, DE
  • NPI 1275683146
  NPD (past)
• Tina Charline Baynard

  • Addiction (Substance Use Disorder) Counselor
  • Georgetown, DE
  • NPI 1144507443
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1346320983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2713 LANCASTER AVE",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198055220",
            "telephone_number": "302-225-9267",
            "fax_number": "302-655-8920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2713 LANCASTER AVE",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198055220",
            "telephone_number": "302-225-9267",
            "fax_number": "302-655-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDYWINE COUNSELING & COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "deactivation_date": "2022-08-30",
        "reactivation_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "FAHEY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "302-225-9269",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000884757",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000024022",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000047051",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandywine Care,LLC
• Brandywine Center for Autism, LLC (Brightbloom Centers)
• Brandywine Center for Wellness
• Brandywine Chiropractic
• Brandywine Convalescent Home, Inc.
• Brandywine Eye Center P.a.
• Brandywine Eye Center PA
• Brandywine Family Medicine, PA
• Brandywine Foot Care
• Brandywine Health and Wellness LLC (First State Health and Wellness)

• Adult Mental Health Clinic/Center in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Adult Mental Health Clinic/Center in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.