Provider Demographics
NPI:1366142853
Name:DANIELS DYNAMIC THERAPY AND CONSULTING , LLC
Entity type:Organization
Organization Name:DANIELS DYNAMIC THERAPY AND CONSULTING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOTAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW, LCSW
Authorized Official - Phone:443-858-1383
Mailing Address - Street 1:4227 DUNWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1323
Mailing Address - Country:US
Mailing Address - Phone:443-858-1383
Mailing Address - Fax:
Practice Address - Street 1:4227 DUNWOOD TER
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1323
Practice Address - Country:US
Practice Address - Phone:443-858-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty