Provider Demographics
NPI:1124413208
Name:GARDNER, DANNIELLE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANNIELLE
Middle Name:LEE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SHILOH RD NW STE 710
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7157
Mailing Address - Country:US
Mailing Address - Phone:770-792-0079
Mailing Address - Fax:888-394-1986
Practice Address - Street 1:1301 SHILOH RD NW STE 710
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7157
Practice Address - Country:US
Practice Address - Phone:770-792-0079
Practice Address - Fax:888-394-1986
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional