Healthcare Provider Details

I. General information

NPI: 1952863631
Provider Name (Legal Business Name): DANIELLE JULIA SILLS LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENSINGTON DR APT 806
JACKSONVILLE NC
28546-7153
US

IV. Provider business mailing address

800 KENSINGTON DR APT 806
JACKSONVILLE NC
28546-7153
US

V. Phone/Fax

Practice location:
  • Phone: 929-405-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: