Healthcare Provider Details

I. General information

NPI: 1407776743
Provider Name (Legal Business Name): KERRY CHRISTINE DANIELS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD DEPT 32E
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

5505 CORPORATE DR
TROY MI
48098-2859
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-1210
  • Fax:
Mailing address:
  • Phone: 248-858-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801072789
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: