Healthcare Provider Details

I. General information

NPI: 1699505461
Provider Name (Legal Business Name): DEON LAVELLE DARNELL CSAC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 FOREHAND DR
CHESAPEAKE VA
23323-2006
US

IV. Provider business mailing address

2856 FOREHAND DR
CHESAPEAKE VA
23323-2006
US

V. Phone/Fax

Practice location:
  • Phone: 757-861-9020
  • Fax:
Mailing address:
  • Phone: 757-861-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number0704013730
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710102886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: