Provider Demographics
NPI:1164820924
Name:PATTERSON, DARRELL (MS)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 HAMLET CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6302
Mailing Address - Country:US
Mailing Address - Phone:407-780-1472
Mailing Address - Fax:
Practice Address - Street 1:981 HAMLET CT
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6302
Practice Address - Country:US
Practice Address - Phone:407-780-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6080487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health