MEDICARE: TOMICA LAWONNE DANIELS

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
1	101Y00000X	Counselor
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1447624291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMICA LAWONNE DANIELS

Provider Business Mailing Address
First Line	:	109 CHEVY LN STE C
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-1561
Country	:	US
Telephone Number	:	318-346-6542
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 CHEVY LN STE C
Second Line	:
City	:	BUNKIE
State	:	LA
Zip	:	71322-1561
Country	:	US
Telephone Number	:	318-346-6542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	03/20/2019

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Directions to “ TOMICA LAWONNE DANIELS ” Practice Location

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