Provider Demographics
NPI:1336470855
Name:CARR, DANIELLE LISA MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LISA MARIE
Last Name:CARR
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 ENERGY PARK DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5276
Mailing Address - Country:US
Mailing Address - Phone:651-646-3959
Mailing Address - Fax:
Practice Address - Street 1:1360 ENERGY PARK DR
Practice Address - Street 2:SUITE 340
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5276
Practice Address - Country:US
Practice Address - Phone:651-646-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC00856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional