=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912763012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHALSAE DARR CDCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 COSHOCTON AVE STE A
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43050-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-326-6110
-----------------------------------------------------
Fax | 800-480-7578
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 N MAIN ST APT A
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43050-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-390-7736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CDCA.191451
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------