Healthcare Provider Details

I. General information

NPI: 1780384883
Provider Name (Legal Business Name): DANIELLE VINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GULF BREEZE PKWY
GULF BREEZE FL
32563-5623
US

IV. Provider business mailing address

10062 NAVARRE PKWY PMB 5003
NAVARRE FL
32566-3013
US

V. Phone/Fax

Practice location:
  • Phone: 850-604-3574
  • Fax: 850-353-8823
Mailing address:
  • Phone: 850-604-3574
  • Fax: 850-353-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119434
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020624
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: