Provider Demographics
NPI:1750585998
Name:DARDEN, STACIE LYNN (PLADC)
Entity type:Individual
Prefix:MISS
First Name:STACIE
Middle Name:LYNN
Last Name:DARDEN
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5768
Mailing Address - Country:US
Mailing Address - Phone:712-322-4689
Mailing Address - Fax:
Practice Address - Street 1:2406 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2013
Practice Address - Country:US
Practice Address - Phone:402-453-5656
Practice Address - Fax:402-455-1811
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-519101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)