=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649660333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LASHIELA DARDEN LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2015
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 CENTER ST
-----------------------------------------------------
City | CLIO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48420-1134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-250-4821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 CENTER ST
-----------------------------------------------------
City | CLIO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48420-1134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-686-7313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 801087422
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801087422
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------