Healthcare Provider Details

I. General information

NPI: 1174151732
Provider Name (Legal Business Name): VINCENT MITCHEL DANIELS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCENT MITCHEL DANIELS M. ED, BCBA

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 W LONG LAKE RD STE 101
TROY MI
48098-4443
US

IV. Provider business mailing address

22767 FIRWOOD AVE
EASTPOINTE MI
48021-3508
US

V. Phone/Fax

Practice location:
  • Phone: 248-840-0794
  • Fax:
Mailing address:
  • Phone: 248-241-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: