Provider Demographics
NPI:1114421872
Name:DARBY, JACQUELIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELIN
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-0223
Mailing Address - Country:US
Mailing Address - Phone:240-273-4524
Mailing Address - Fax:
Practice Address - Street 1:215 DONELSON PIKE UNIT 148262
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2998
Practice Address - Country:US
Practice Address - Phone:240-273-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical