Provider Demographics
NPI:1407249782
Name:HARTLEY, DARRELL (LAADC ICADC CADC-II)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:LAADC ICADC CADC-II
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 700874
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-0874
Mailing Address - Country:US
Mailing Address - Phone:469-289-8077
Mailing Address - Fax:
Practice Address - Street 1:4524 LEE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4157
Practice Address - Country:US
Practice Address - Phone:972-741-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA07240315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)