Darryl Glen Funk, LSATP

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

0718000027 Issued in VA

Practice address

521 N Quincy St
Arlington, VA 22203-2136

Phone

(703) 841-0703

Fax

(703) 841-2316

NPI assigned

Sep 25, 2008

Last updated

Sep 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222300800000",
    "number": "1568612679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 N QUINCY ST.",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031785",
            "telephone_number": "703-841-0703",
            "fax_number": "703-841-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 N QUINCY ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222032136",
            "telephone_number": "703-841-0703",
            "fax_number": "703-841-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNK",
        "first_name": "DARRYL",
        "middle_name": "GLEN",
        "credential": "LSATP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-25",
        "last_updated": "2008-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "VA",
            "license": "0718000027",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558415968",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Arlington, VA
• Providers in Arlington, VA by specialty
• Substance Abuse Rehabilitation Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.