Provider Demographics
NPI:1083066476
Name:MCDONALD, DANIEL JOE (LCADC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3718
Mailing Address - Country:US
Mailing Address - Phone:502-995-3350
Mailing Address - Fax:502-995-3384
Practice Address - Street 1:7160 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3718
Practice Address - Country:US
Practice Address - Phone:502-995-3350
Practice Address - Fax:502-995-3384
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165872101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)