Provider Demographics
NPI:1578091997
Name:GLASSON-DARLING, DAX (ASW, MT-BC)
Entity Type:Individual
Prefix:
First Name:DAX
Middle Name:
Last Name:GLASSON-DARLING
Suffix:
Gender:F
Credentials:ASW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 S 45TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-4412
Mailing Address - Country:US
Mailing Address - Phone:619-452-9647
Mailing Address - Fax:
Practice Address - Street 1:819 S 45TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-4412
Practice Address - Country:US
Practice Address - Phone:619-452-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW958051041C0700X
390200000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program