Provider Demographics
NPI:1447560172
Name:WITASEK, DARCI (MA LMFT)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:WITASEK
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 BOONE AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1089
Mailing Address - Country:US
Mailing Address - Phone:763-550-3193
Mailing Address - Fax:
Practice Address - Street 1:7600 BOONE AVE N STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1089
Practice Address - Country:US
Practice Address - Phone:763-550-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist