Provider Demographics
NPI:1891103883
Name:DARLING, DAWN R (LICSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:DARLING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 ANTELOPE AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-9437
Mailing Address - Country:US
Mailing Address - Phone:308-746-1857
Mailing Address - Fax:308-455-8606
Practice Address - Street 1:2804 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3500
Practice Address - Country:US
Practice Address - Phone:308-455-8605
Practice Address - Fax:308-455-8606
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16841041C0700X
NE1863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1811311665Medicaid
NE100263857-00Medicaid
NE13938900OtherCAQH