Provider Demographics
NPI:1972119022
Name:LARK-DARIEN, LASHAUNDA RENAE
Entity Type:Individual
Prefix:
First Name:LASHAUNDA
Middle Name:RENAE
Last Name:LARK-DARIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13738 BRANDON JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-1883
Mailing Address - Country:US
Mailing Address - Phone:205-861-5445
Mailing Address - Fax:
Practice Address - Street 1:13738 BRANDON JAMES AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-1883
Practice Address - Country:US
Practice Address - Phone:205-861-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical