Provider Demographics
NPI:1275928798
Name:BINGHAM, DANIELLE FARRA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:FARRA
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15025 DURBIN COVE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7041
Mailing Address - Country:US
Mailing Address - Phone:352-217-6200
Mailing Address - Fax:
Practice Address - Street 1:12058 SAN JOSE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8669
Practice Address - Country:US
Practice Address - Phone:352-217-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health