Healthcare Provider Details

I. General information

NPI: 1417304494
Provider Name (Legal Business Name): DANIELLE CARRIE O'WADE MA LPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE CARRIE DUPRES MA LPC NCC

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CIRCLE DRIVE SUITE 103
ROSTRAVER TOWNSHIP PA
15012
US

IV. Provider business mailing address

1630 ROSTRAVER ROAD
BELLE VERNON PA
15012
US

V. Phone/Fax

Practice location:
  • Phone: 724-757-2845
  • Fax:
Mailing address:
  • Phone: 724-757-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC008938
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC008938
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: