Provider Demographics
NPI:1639812415
Name:DD THERAPY SOURCES LLC
Entity Type:Organization
Organization Name:DD THERAPY SOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LBSC, LPC, NCC
Authorized Official - Phone:215-341-1020
Mailing Address - Street 1:87 OLD CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2045
Mailing Address - Country:US
Mailing Address - Phone:215-341-1020
Mailing Address - Fax:267-627-2848
Practice Address - Street 1:2630 W CHELTENHAM AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1311
Practice Address - Country:US
Practice Address - Phone:215-341-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty