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General NPI Number Information
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NPI Number | 1649710096
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Entity Type | Individual
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Provider Name | DARRELL KEITH CHOATES SR. CARE GIVER
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Gender | Male
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Dates
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Enumeration Date | 03/05/2017
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Last Update Date | 03/21/2020
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Provider Practice Location Address
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Address Line | 120 PEACE LN
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City | GLASSBORO
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State | NJ
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Zip | 08028-3221
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Country | US
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Telephone | 267-078-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 120 PEACE LN
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City | GLASSBORO
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State | NJ
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Zip | 08028-3221
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Country | US
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Telephone | 267-078-3040
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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