Provider Demographics
NPI:1962106310
Name:WILCHUSKY, DARLA LYON
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:LYON
Last Name:WILCHUSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BENTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4813
Mailing Address - Country:US
Mailing Address - Phone:850-797-9602
Mailing Address - Fax:
Practice Address - Street 1:435 S RIDGEWOOD AVE STE 204C-205
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4927
Practice Address - Country:US
Practice Address - Phone:386-747-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health