Provider Demographics
NPI:1023185790
Name:SERRITELLA, DANIEL A (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:SERRITELLA
Suffix:
Gender:M
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2293
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237
Mailing Address - Country:US
Mailing Address - Phone:770-478-7802
Mailing Address - Fax:770-471-8494
Practice Address - Street 1:172 NORTH AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30237
Practice Address - Country:US
Practice Address - Phone:770-478-7802
Practice Address - Fax:770-471-8494
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA241101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist