Healthcare Provider Details

I. General information

NPI: 1285286013
Provider Name (Legal Business Name): DANIELLE ALLEN CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 N BUFFALO DRIVE STE 100
LAS VEGAS NV
89129
US

IV. Provider business mailing address

3321 N BUFFALO DR STE 200
LAS VEGAS NV
89129
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-1373
  • Fax: 702-515-1379
Mailing address:
  • Phone: 702-515-1373
  • Fax: 702-515-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00814-C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00814-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: