MEDICARE: DANIELLE LEIGH WARREN

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	16980	CA

General Provider Information

NPI Number	:	1932956067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LEIGH WARREN

Provider Business Mailing Address
First Line	:	2180 JOHNSON AVE
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4558
Country	:	US
Telephone Number	:	805-226-3201
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 4TH ST
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-3173
Country	:	US
Telephone Number	:	805-226-3201
Fax Number	:

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

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	12/12/2024

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Directions to “ DANIELLE LEIGH WARREN ” Practice Location

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