Provider Demographics
NPI:1013024942
Name:CARLOCK, DANIEL M
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:CARLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:CARLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLPC, CAADC
Mailing Address - Street 1:1089 MAPLE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-1814
Mailing Address - Country:US
Mailing Address - Phone:586-770-7866
Mailing Address - Fax:
Practice Address - Street 1:800 STEPHENSON HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1123
Practice Address - Country:US
Practice Address - Phone:248-585-3239
Practice Address - Fax:248-616-9759
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional