Healthcare Provider Details

I. General information

NPI: 1609853753
Provider Name (Legal Business Name): DARRELL M GUEST LISW-S, LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/28/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WOODMAN DR SUITE 200
DAYTON OH
45432-3497
US

IV. Provider business mailing address

1320 WOODMAN DR SUITE 200
DAYTON OH
45432-3497
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-1781
  • Fax: 937-853-0096
Mailing address:
  • Phone: 937-223-1781
  • Fax: 937-853-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001182
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1302017
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberW909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: