Provider Demographics
NPI:1164672028
Name:DANIELS, TERRY R (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 MORNINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3509
Mailing Address - Country:US
Mailing Address - Phone:973-930-4641
Mailing Address - Fax:
Practice Address - Street 1:5906 MORNINGBIRD LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3509
Practice Address - Country:US
Practice Address - Phone:973-930-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104100000X
MD144811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD941L70Medicare PIN
MD58956180Medicaid