Provider Demographics
NPI:1194597971
Name:PREVOST, DANIELLA ANNE (LMHC)
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:ANNE
Last Name:PREVOST
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 W SAMPLE RD APT 2203
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2645
Mailing Address - Country:US
Mailing Address - Phone:954-394-2081
Mailing Address - Fax:
Practice Address - Street 1:505 S FEDERAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4147
Practice Address - Country:US
Practice Address - Phone:866-534-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health