Provider Demographics
NPI:1871774901
Name:BASKERVILLE, MONEAK C (MS, MFT, LPC, LMHPC)
Entity type:Individual
Prefix:
First Name:MONEAK
Middle Name:C
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:MS, MFT, LPC, LMHPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 N REDSPIRE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3947
Mailing Address - Country:US
Mailing Address - Phone:302-834-5242
Mailing Address - Fax:302-834-7532
Practice Address - Street 1:3301 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2738
Practice Address - Country:US
Practice Address - Phone:302-834-5242
Practice Address - Fax:302-834-7532
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional