Provider Demographics
NPI:1427268994
Name:DANIELS, KARLA CONDITT (LMFT , MDIV)
Entity type:Individual
Prefix:
First Name:KARLA CONDITT
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LMFT , MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 OVERTON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3455
Mailing Address - Country:US
Mailing Address - Phone:706-733-7096
Mailing Address - Fax:
Practice Address - Street 1:3131 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3299
Practice Address - Country:US
Practice Address - Phone:706-733-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
GAMFT000947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist