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NPI Code Detail

MEDICARE: DEON LAVELLE DARNELL CSAC, CADC

MEDICARE: DEON LAVELLE DARNELL CSAC, CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0400XAddiction (Substance Use Disorder) Psychologist0704013730VA
2101YA0400XAddiction (Substance Use Disorder) Counselor0710102886VA

General Provider Information

NPI Number : 1699505461
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEON LAVELLE DARNELL CSAC, CADC
Provider Business Mailing Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number : 757-861-9020
Fax Number :
Provider Business Practice Location Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number : 757-861-9020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2024
Last Update Date : 08/06/2024

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