Provider Demographics
NPI:1699079301
Name:STARTIN, DARREL R JR (BA, CDP)
Entity type:Individual
Prefix:MR
First Name:DARREL
Middle Name:R
Last Name:STARTIN
Suffix:JR
Gender:M
Credentials:BA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 E TRENT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4218
Mailing Address - Country:US
Mailing Address - Phone:509-926-3361
Mailing Address - Fax:
Practice Address - Street 1:9415 E TRENT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4218
Practice Address - Country:US
Practice Address - Phone:509-926-3361
Practice Address - Fax:509-927-8420
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00004556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA32 1433 00OtherWA STATE CERTIFIED TREATMENT AGENCY
WACP00004556OtherCHEMICAL DEPENDENCY PROFESSIONAL