Provider Demographics
NPI:1164147948
Name:MCDANIELS, MICHAEL (CDCA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCDANIELS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18675 PARKLAND DR APT 408
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3467
Mailing Address - Country:US
Mailing Address - Phone:216-386-9202
Mailing Address - Fax:
Practice Address - Street 1:18675 PARKLAND DR APT 408
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-3467
Practice Address - Country:US
Practice Address - Phone:216-386-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180896101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)