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General NPI Number Information
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NPI Number | 1578780219
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Entity Type | Individual
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Provider Name | MARK DARRELL DRISKILL LICSW
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 3940 MONTCLAIR RD STE 205
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-2416
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Country | US
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Telephone | 205-612-0260
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Fax | 205-871-5939
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Provider Business Mailing Address
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Address Line | 3448 CROSSINGS WAY
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4457
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6472
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2187C-0923
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License Number State | AL
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