Provider Demographics
NPI:1922579218
Name:DARCEY FAIRCHILD, LCSW, LLC
Entity Type:Organization
Organization Name:DARCEY FAIRCHILD, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARCEY
Authorized Official - Middle Name:SANT
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-599-7780
Mailing Address - Street 1:1018 BURLINGTON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5666
Mailing Address - Country:US
Mailing Address - Phone:406-599-7780
Mailing Address - Fax:
Practice Address - Street 1:1018 BURLINGTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5666
Practice Address - Country:US
Practice Address - Phone:406-599-7780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)