Healthcare Provider Details

I. General information

NPI: 1376958546
Provider Name (Legal Business Name): DANIELS DISCOVERY DYNAMICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 CHEROKEE RD
FLORENCE SC
29501-4184
US

IV. Provider business mailing address

1803 CHEROKEE RD
FLORENCE SC
29501-4184
US

V. Phone/Fax

Practice location:
  • Phone: 843-661-6030
  • Fax: 843-679-2633
Mailing address:
  • Phone: 843-661-6030
  • Fax: 843-679-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number5468
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number5468
License Number StateSC

VIII. Authorized Official

Name: PREZILLIC DANIELS
Title or Position: OWNER/COUNSELOR
Credential: MA, LPC, RPT
Phone: 843-661-6030