Provider Demographics
NPI:1518469204
Name:BARKSDALE, DARIA (LCMHC)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:DARIA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1900
Mailing Address - Fax:
Practice Address - Street 1:200 DAVIS PARK RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-0116
Practice Address - Country:US
Practice Address - Phone:704-866-6618
Practice Address - Fax:704-874-9001
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13781101YM0800X
NCA13781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty