Healthcare Provider Details

I. General information

NPI: 1619090248
Provider Name (Legal Business Name): HAROLD CLIFFORD DARST CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 NW 6TH ST
CORVALLIS OR
97330-4814
US

IV. Provider business mailing address

619 NW 29TH ST
CORVALLIS OR
97330-5240
US

V. Phone/Fax

Practice location:
  • Phone: 541-954-7077
  • Fax: 888-505-1903
Mailing address:
  • Phone: 541-954-7077
  • Fax: 888-505-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number99-11-61
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: