Provider Demographics
NPI:1174351571
Name:SHORT, DARIN (MACC)
Entity type:Individual
Prefix:MR
First Name:DARIN
Middle Name:
Last Name:SHORT
Suffix:
Gender:M
Credentials:MACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 TIFTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4484
Mailing Address - Country:US
Mailing Address - Phone:704-577-0284
Mailing Address - Fax:
Practice Address - Street 1:8406 TIFTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4484
Practice Address - Country:US
Practice Address - Phone:704-577-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health