Provider Demographics
NPI:1720277767
Name:MCALLISTER, DARRYL X (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:X
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1004
Mailing Address - Country:US
Mailing Address - Phone:910-738-1587
Mailing Address - Fax:910-738-1581
Practice Address - Street 1:3581 LACKEY ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-9048
Practice Address - Country:US
Practice Address - Phone:910-738-1587
Practice Address - Fax:910-738-1581
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002691041C0700X
NCLCAS-1610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC55400OtherBCBS NC
NC6002598Medicaid
NC6002928Medicaid