Provider Demographics
NPI:1316339872
Name:FAIRCHILD, DARCEY (LCSW)
Entity type:Individual
Prefix:
First Name:DARCEY
Middle Name:
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BURLINGTON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5666
Mailing Address - Country:US
Mailing Address - Phone:406-599-7780
Mailing Address - Fax:
Practice Address - Street 1:1018 BURLINGTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5666
Practice Address - Country:US
Practice Address - Phone:406-599-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-114741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical