Provider Demographics
NPI:1326523531
Name:MONFILS, DARROL (CADCII, ICADC)
Entity type:Individual
Prefix:
First Name:DARROL
Middle Name:
Last Name:MONFILS
Suffix:
Gender:M
Credentials:CADCII, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5979
Mailing Address - Country:US
Mailing Address - Phone:909-981-6121
Mailing Address - Fax:909-920-9710
Practice Address - Street 1:239 W 9TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5979
Practice Address - Country:US
Practice Address - Phone:909-981-6121
Practice Address - Fax:909-920-9710
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA011210315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA011210315Medicaid