Healthcare Provider Details

I. General information

NPI: 1891630448
Provider Name (Legal Business Name): JESSICA DALY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TWELVE OAKS DR
SMITHS STATION AL
36877-4240
US

IV. Provider business mailing address

333 TWELVE OAKS DR
SMITHS STATION AL
36877-4240
US

V. Phone/Fax

Practice location:
  • Phone: 760-712-7338
  • Fax:
Mailing address:
  • Phone: 760-712-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: