Provider Demographics
NPI:1154729333
Name:DANIELS, KATIE C
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:C
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-9151
Mailing Address - Country:US
Mailing Address - Phone:912-217-7078
Mailing Address - Fax:
Practice Address - Street 1:1119 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305
Practice Address - Country:US
Practice Address - Phone:912-217-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service