Healthcare Provider Details

I. General information

NPI: 1477468668
Provider Name (Legal Business Name): DANIELLE VAN WAGENEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 SPRING HILL DR
RICHMOND HILL GA
31324-6773
US

IV. Provider business mailing address

359 SPRING HILL DR
RICHMOND HILL GA
31324-6773
US

V. Phone/Fax

Practice location:
  • Phone: 912-231-7378
  • Fax: 912-428-8755
Mailing address:
  • Phone: 912-231-7378
  • Fax: 912-428-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANIELLLE VANWAGENEN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 912-231-7378