Provider Demographics
NPI:1770583304
Name:LIND, DARRELL T (PA-C, MS, MPH)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:T
Last Name:LIND
Suffix:
Gender:M
Credentials:PA-C, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W MISSION ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2782
Mailing Address - Country:US
Mailing Address - Phone:805-252-5610
Mailing Address - Fax:
Practice Address - Street 1:109 W MISSION ST APT B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2782
Practice Address - Country:US
Practice Address - Phone:805-252-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17700363AM0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM412ZMedicare UPIN