Healthcare Provider Details

I. General information

NPI: 1861094435
Provider Name (Legal Business Name): DANIELLE DUCHARME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 ATLANTA RD
CUMMING GA
30040-2705
US

IV. Provider business mailing address

703 ATLANTA RD
CUMMING GA
30040-2705
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-6204
  • Fax:
Mailing address:
  • Phone: 770-886-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45778
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: