Organization Active NPI

Self Realization Consulting, Inc.

Doing business as Self Realization

  • Clinical Psychologist
  • Middletown, DE
National Provider Identifier
1487778247
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
B1-0000757 Issued in DE
Legal business name
SELF REALIZATION CONSULTING, INC.
Doing business as
Self Realization
Practice address
507 Lilac Dr
Middletown, DE 19709-8639
Phone
(302) 312-8221
Fax
(302) 378-9128
NPI assigned
Mar 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Earl Eugene Walker Jr., ED.D.
Title
Owner, President
Phone
(302) 312-8221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X B1-0000757 DE Primary

Addresses

Primary practice location

507 Lilac Dr
Middletown, DE 19709-8639

Mailing address

507 Lilac Dr
Middletown, DE 19709-8639
Phone (302) 312-8221

Other names 1

  • Self Realization Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487778247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 LILAC DR",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197098639",
            "telephone_number": "302-312-8221",
            "fax_number": "302-378-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 LILAC DR",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197098639",
            "telephone_number": "302-312-8221",
            "fax_number": "302-378-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REALIZATION CONSULTING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "302-312-8221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "DE",
            "license": "B1-0000757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Self Realization",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Middletown, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.