Provider Demographics
NPI:1194201541
Name:SCANLON, DANIELLE (LPC, LMHC, LISAC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:LPC, LMHC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 COUNTY ROAD 79
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9455
Mailing Address - Country:US
Mailing Address - Phone:850-518-2151
Mailing Address - Fax:
Practice Address - Street 1:2285 COUNTY ROAD 79
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-9455
Practice Address - Country:US
Practice Address - Phone:850-518-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20779101YP2500X
ID48724101YP2500X
101Y00000X
FL18725101YM0800X
AZ15092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)