Provider Demographics
NPI:1275159352
Name:ST. CLEMMONS, DARRELL
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:ST. CLEMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CANAL ST APT 407
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-3262
Mailing Address - Country:US
Mailing Address - Phone:401-396-7580
Mailing Address - Fax:
Practice Address - Street 1:200 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1119
Practice Address - Country:US
Practice Address - Phone:603-953-0077
Practice Address - Fax:603-953-0078
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)