MEDICARE: MS. TRACI DANIEL LMFT ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	10486	SC

General Provider Information

NPI Number	:	1376433904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACI DANIEL LMFT ASSOCIATE

Provider Business Mailing Address
First Line	:	305 NEWBROOK DR UNIT 3302
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-7122
Country	:	US
Telephone Number	:	949-280-4372
Fax Number	:

Provider Business Practice Location Address
First Line	:	1985 RIVIERA DR STE 103
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7582
Country	:	US
Telephone Number	:	949-280-4372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	02/05/2026

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