Healthcare Provider Details

I. General information

NPI: 1215177266
Provider Name (Legal Business Name): DAO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103B FREE BRIDGE LN
CHARLOTTESVILLE VA
22911-8446
US

IV. Provider business mailing address

103B FREE BRIDGE LN
CHARLOTTESVILLE VA
22911-8446
US

V. Phone/Fax

Practice location:
  • Phone: 434-293-3165
  • Fax:
Mailing address:
  • Phone: 434-293-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006888
License Number StateVA

VIII. Authorized Official

Name: LAURA ELIZABETH GILES
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 434-293-3165