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General NPI Number Information
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NPI Number | 1487292587
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Entity Type | Individual
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Provider Name | DARRYL POOLE
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Gender | Male
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 2100 NAPA VALLEJO HWY
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City | NAPA
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State | CA
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Zip | 94558-6234
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Country | US
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Telephone | 707-255-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 5909 BAMFORD DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-4635
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Country | US
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Telephone | 916-430-5445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C6530513
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License Number State | CA
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