Healthcare Provider Details

I. General information

NPI: 1790245652
Provider Name (Legal Business Name): NICHOLE DARBY FOSTER BA, CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICHOLE DARBY DRISCOLL BA, CADC I

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44359 PALM ST
INDIO CA
92201-3116
US

IV. Provider business mailing address

44359 PALM ST
INDIO CA
92201-3116
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-6616
  • Fax: 760-775-7887
Mailing address:
  • Phone: 760-342-6616
  • Fax: 760-775-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI20961018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: