Healthcare Provider Details

I. General information

NPI: 1487292587
Provider Name (Legal Business Name): DARRYL POOLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY
NAPA CA
94558-6234
US

IV. Provider business mailing address

5909 BAMFORD DR
SACRAMENTO CA
95823-4635
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-8001
  • Fax:
Mailing address:
  • Phone: 916-430-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC6530513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: