Healthcare Provider Details

I. General information

NPI: 1831785310
Provider Name (Legal Business Name): DANIELLE CESAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 SHADOWBROOKE CIR
LOGANVILLE GA
30052-8248
US

IV. Provider business mailing address

318 SHADOWBROOKE CIR
LOGANVILLE GA
30052-8248
US

V. Phone/Fax

Practice location:
  • Phone: 470-641-1667
  • Fax:
Mailing address:
  • Phone: 240-480-8548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012872
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: