Healthcare Provider Details

I. General information

NPI: 1790694685
Provider Name (Legal Business Name): JAMIE DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S LEMON AVE # 9892
WALNUT CA
91789-2706
US

IV. Provider business mailing address

7 HORIZON DR
NORWALK CT
06854-2651
US

V. Phone/Fax

Practice location:
  • Phone: 415-403-2156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7859
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: