Provider Demographics
NPI:1184161168
Name:DARDEN, LONNICA
Entity type:Individual
Prefix:
First Name:LONNICA
Middle Name:
Last Name:DARDEN
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 1:3040 AVEMORE SQUARE PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7228
Mailing Address - Country:US
Mailing Address - Phone:703-496-7804
Mailing Address - Fax:540-898-1040
Practice Address - Street 1:7611 COPPERMINE DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2668
Practice Address - Country:US
Practice Address - Phone:703-496-7804
Practice Address - Fax:540-898-1040
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103K00000X
101Y00000X
VA09040105921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty