Provider Demographics
NPI:1699075911
Name:MCDANIELS, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MCDANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 OLD SONOMA RD
Mailing Address - Street 2:BUILDING J RM. 109
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3708
Mailing Address - Country:US
Mailing Address - Phone:707-253-4775
Mailing Address - Fax:
Practice Address - Street 1:2344 OLD SONOMA RD.
Practice Address - Street 2:BUILDING J ROOM 109
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559
Practice Address - Country:US
Practice Address - Phone:707-253-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health