Healthcare Provider Details

I. General information

NPI: 1467768994
Provider Name (Legal Business Name): DANIELLE PHILYAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2010
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 NE 14TH ST APT 5
POMPANO BEACH FL
33062-3564
US

IV. Provider business mailing address

5324 RADFORD LOOP
FAIRBURN GA
30213-1132
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-7885
  • Fax: 954-342-0273
Mailing address:
  • Phone: 404-227-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014053
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: