Provider Demographics
NPI:1568037513
Name:DARNELL, CARLA (MS, MED)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:DARNELL
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 KINGSGATE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1505
Mailing Address - Country:US
Mailing Address - Phone:614-326-0452
Mailing Address - Fax:
Practice Address - Street 1:1460 KINGSGATE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1505
Practice Address - Country:US
Practice Address - Phone:614-326-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0001139-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health