Provider Demographics
NPI:1982466215
Name:BETHEL, DARRIUS OMAR (MBA, MA, LMHP-R)
Entity Type:Individual
Prefix:MR
First Name:DARRIUS
Middle Name:OMAR
Last Name:BETHEL
Suffix:
Gender:M
Credentials:MBA, MA, LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1093
Mailing Address - Country:US
Mailing Address - Phone:434-222-5716
Mailing Address - Fax:
Practice Address - Street 1:1937 ALLEN PL
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1093
Practice Address - Country:US
Practice Address - Phone:434-222-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health