Self Realization, LLC

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

B10000757 Issued in DE

Legal business name

SELF REALIZATION, LLC

Doing business as

Wisdom Counseling

Practice address

102 Sleepy Hollow Dr
Ste 200
Middletown, DE 19709-5841

Phone

(302) 312-8221

NPI assigned

Nov 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Earl Walker Jr., ED.D.

Title

Executive Director

Phone

(302) 312-8221

Specialties & licenses 1

Addresses

Other names 1

• Wisdom Counseling Doing business as

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

{
    "created_epoch": "1258934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1487982880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 MORNING DEW DR",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197092419",
            "telephone_number": "302-312-8221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 SLEEPY HOLLOW DR",
            "address_2": "STE 200",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197095841",
            "telephone_number": "302-312-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF REALIZATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-23",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "302-312-8221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": "DE",
            "license": "B10000757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisdom Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Psychologist in Middletown, DE
• Providers in Middletown, DE by specialty
• Health Service Psychologist in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.