Healthcare Provider Details

I. General information

NPI: 1265770788
Provider Name (Legal Business Name): MISS DANIELLE CHRISTINA LAYCOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E ALBERTONI ST 109
CARSON CA
90746-1539
US

IV. Provider business mailing address

3450 EMERALD ST 15
TORRANCE CA
90503-3723
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-0063
  • Fax:
Mailing address:
  • Phone: 805-907-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: