Healthcare Provider Details

I. General information

NPI: 1164342267
Provider Name (Legal Business Name): DARREL ISAAC QMHP, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1553
HAMPTON VA
23661-0553
US

IV. Provider business mailing address

712 ALBERTINE CT
CHESAPEAKE VA
23320-6775
US

V. Phone/Fax

Practice location:
  • Phone: 757-254-2377
  • Fax:
Mailing address:
  • Phone: 929-241-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0732013976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: