Healthcare Provider Details

I. General information

NPI: 1588338669
Provider Name (Legal Business Name): DANESA DANIELLE HARBISON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANESA DANIELLE MARSHALL-CLEMONS BSW

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E RIVER RD
MORAINE OH
45439-1538
US

IV. Provider business mailing address

4041 RUNDELL DR
DAYTON OH
45415-1416
US

V. Phone/Fax

Practice location:
  • Phone: 937-985-3703
  • Fax:
Mailing address:
  • Phone: 937-972-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2208056
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: