Individual
DARRYL GLEN FUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSATP
Contact information
Practice address
521 N QUINCY ST, ARLINGTON, VA 22203-2136
(703) 841-0703
(703) 841-2316
Mailing address
521 N QUINCY ST., ARLINGTON, VA 22203-1785
(703) 841-0703
(703) 841-2316
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
0718000027
VA
324500000X
Substance Abuse Rehabilitation Facility
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558415968
—
VA
Enumeration date
09/25/2008
Last updated
09/25/2008
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