Provider Demographics
NPI:1518561828
Name:WILEY, DARREN CHRISTOPHER (MA, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:CHRISTOPHER
Last Name:WILEY
Suffix:
Gender:M
Credentials:MA, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 POCAHONTAS RD
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-4242
Mailing Address - Country:US
Mailing Address - Phone:304-359-0493
Mailing Address - Fax:
Practice Address - Street 1:834 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-4242
Practice Address - Country:US
Practice Address - Phone:304-359-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11142101YP2500X
WV2544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional