Provider Demographics
NPI:1992071054
Name:DANIELS, ERIC RENE I (CDP)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RENE
Last Name:DANIELS
Suffix:I
Gender:M
Credentials:CDP
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:RENE
Other - Last Name:DANIELS
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:CDP
Mailing Address - Street 1:24624 101ST PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5174
Mailing Address - Country:US
Mailing Address - Phone:206-323-0930
Mailing Address - Fax:
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:206-323-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60235877101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)