Basic Information
| Provider Information | |||||||||
| NPI: | 1679097844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DARROW | ||||||||
| FirstName: | MARJORY | ||||||||
| MiddleName: | JILL | ||||||||
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| Credential: | CADC -II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12125 SHALE RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956028880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308851917 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12125 SHALE RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956028880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308851917 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A054260419 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.