Provider Demographics
NPI:1215375316
Name:DANTZLER, DARIN LEWIS
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:LEWIS
Last Name:DANTZLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DARIN
Other - Middle Name:LEWIS
Other - Last Name:DANTZLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3155 HICKORY HILL RD
Mailing Address - Street 2:102 C
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2555
Mailing Address - Country:US
Mailing Address - Phone:901-282-9738
Mailing Address - Fax:901-310-4212
Practice Address - Street 1:3155 HICKORY HILL RD
Practice Address - Street 2:102 C
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2555
Practice Address - Country:US
Practice Address - Phone:901-282-9738
Practice Address - Fax:901-310-4212
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)