Healthcare Provider Details

I. General information

NPI: 1366009581
Provider Name (Legal Business Name): DANIELLE JWEID LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 BRADFORD RD STE 102
VIRGINIA BEACH VA
23455-4094
US

IV. Provider business mailing address

1553 BRADFORD RD
VIRGINIA BEACH VA
23455-4094
US

V. Phone/Fax

Practice location:
  • Phone: 757-453-2144
  • Fax:
Mailing address:
  • Phone: 757-453-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number15-217
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: