Healthcare Provider Details

I. General information

NPI: 1205854775
Provider Name (Legal Business Name): BETTY DANIELS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

17304 STEEL ST
DETROIT MI
48235-1444
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-7802
  • Fax: 586-576-5468
Mailing address:
  • Phone: 248-559-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801004469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: