MEDICARE: MS. AGNES MARIA MCDANIEL CAC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689011363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AGNES MARIA MCDANIEL CAC II

Provider Business Mailing Address
First Line	:	4380 FURMAN FIELD RD
Second Line	:
City	:	REMBERT
State	:	SC
Zip	:	29128-9156
Country	:	US
Telephone Number	:	808-983-8277
Fax Number	:

Provider Business Practice Location Address
First Line	:	4380 FURMAN FIELD RD
Second Line	:
City	:	REMBERT
State	:	SC
Zip	:	29128
Country	:	US
Telephone Number	:	808-983-8277
Fax Number	:

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

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	09/02/2016

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