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NPI Code Detail

MEDICARE: THERESA M DANIELS CDCA

MEDICARE: THERESA M DANIELS CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.180430OH

General Provider Information

NPI Number : 1235861949
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA M DANIELS CDCA
Provider Business Mailing Address
First Line : 8515 LYRA DR # 302
Second Line :
City : COLUMBUS
State : OH
Zip : 43240-2026
Country : US
Telephone Number : 740-803-9425
Fax Number :
Provider Business Practice Location Address
First Line : 4160 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3024
Country : US
Telephone Number : 614-875-0079
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2022
Last Update Date : 06/30/2022

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Directions to “ THERESA M DANIELS CDCA” Practice Location

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