Provider Demographics
NPI:1326577594
Name:ANDERSON, DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 COWAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3441
Mailing Address - Country:US
Mailing Address - Phone:985-224-5140
Mailing Address - Fax:
Practice Address - Street 1:1110 COWAN RD STE B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3441
Practice Address - Country:US
Practice Address - Phone:985-224-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty