Healthcare Provider Details

I. General information

NPI: 1669217618
Provider Name (Legal Business Name): DANIELLE MARIE GIACOMINO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE MARIE SKOCILICH LAC

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W MERCURY ST
BUTTE MT
59701-1510
US

IV. Provider business mailing address

2263 WEST DR
BUTTE MT
59701-6175
US

V. Phone/Fax

Practice location:
  • Phone: 406-299-3348
  • Fax: 406-299-3450
Mailing address:
  • Phone: 406-498-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-55816
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: