Provider Demographics
NPI:1235102161
Name:MECKEL, DANIEL JONATHAN (PHD LGSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JONATHAN
Last Name:MECKEL
Suffix:
Gender:M
Credentials:PHD LGSW
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 826
Mailing Address - Street 2:TRICO CORPORATION
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-0826
Mailing Address - Country:US
Mailing Address - Phone:301-862-4966
Mailing Address - Fax:301-862-5554
Practice Address - Street 1:22 INDUSTRIAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2792
Practice Address - Country:US
Practice Address - Phone:301-632-2100
Practice Address - Fax:301-632-2150
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG11938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health