Healthcare Provider Details

I. General information

NPI: 1104568732
Provider Name (Legal Business Name): DANIEL MCCANCE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 SHEPHERDS LN
LOGANVILLE GA
30052-3059
US

IV. Provider business mailing address

3611 SHEPHERDS LN
LOGANVILLE GA
30052-3059
US

V. Phone/Fax

Practice location:
  • Phone: 404-667-5991
  • Fax:
Mailing address:
  • Phone: 140-466-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC011535
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC011535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: