Provider Demographics
NPI:1457132060
Name:HARRELL, DANIELLE SHANAE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHANAE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 POLARIS WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-3849
Mailing Address - Country:US
Mailing Address - Phone:404-663-2462
Mailing Address - Fax:
Practice Address - Street 1:2304 POLARIS WAY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-3849
Practice Address - Country:US
Practice Address - Phone:404-663-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician