Provider Demographics
NPI:1033576996
Name:DARRISAW, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:DARRISAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:DARRISAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:4140 WORLINGTON TER
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-1335
Mailing Address - Country:US
Mailing Address - Phone:772-528-6627
Mailing Address - Fax:772-466-4988
Practice Address - Street 1:4140 WORLINGTON TER
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-1335
Practice Address - Country:US
Practice Address - Phone:772-528-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor