Provider Demographics
NPI:1538905930
Name:VIDAL, DARREN JAMES WILLIAM (MA, LAPC, NCC)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:JAMES WILLIAM
Last Name:VIDAL
Suffix:
Gender:M
Credentials:MA, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1509
Mailing Address - Country:US
Mailing Address - Phone:412-523-8757
Mailing Address - Fax:
Practice Address - Street 1:95 E HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1853
Practice Address - Country:US
Practice Address - Phone:412-523-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000241101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health