Healthcare Provider Details

I. General information

NPI: 1174134340
Provider Name (Legal Business Name): DANIELLE L PHILLIPS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 N COURTENAY PKWY STE 207
MERRITT ISLAND FL
32953-4475
US

IV. Provider business mailing address

2012 ROLLINS DR
COCOA FL
32922-5442
US

V. Phone/Fax

Practice location:
  • Phone: 321-394-8701
  • Fax: 321-208-8187
Mailing address:
  • Phone: 321-616-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH22988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: