Provider Demographics
NPI:1114651775
Name:DANILES, MELANIE (MS COUNSELING)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DANILES
Suffix:
Gender:F
Credentials:MS COUNSELING
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 665
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32053-0665
Mailing Address - Country:US
Mailing Address - Phone:904-729-8972
Mailing Address - Fax:
Practice Address - Street 1:1370 BERRY STREET
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:FL
Practice Address - Zip Code:32053
Practice Address - Country:US
Practice Address - Phone:904-729-8972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100167Medicaid