Provider Demographics
NPI:1922779818
Name:DARDEN, GLADYS JUANITA (LCAS)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:JUANITA
Last Name:DARDEN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 GRANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6137
Mailing Address - Country:US
Mailing Address - Phone:919-703-5458
Mailing Address - Fax:
Practice Address - Street 1:3929 GRANDOVER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6137
Practice Address - Country:US
Practice Address - Phone:919-703-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15909101YA0400X
NC25461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)