Provider Demographics
NPI:1245536648
Name:DICK, DARREN (MSED, BCBA)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:
Last Name:DICK
Suffix:
Gender:M
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3948
Mailing Address - Country:US
Mailing Address - Phone:540-887-9617
Mailing Address - Fax:
Practice Address - Street 1:110 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3948
Practice Address - Country:US
Practice Address - Phone:540-887-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-04-2013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst