Provider Demographics
NPI:1326530445
Name:BARNICLE, DANICA DRUE
Entity Type:Individual
Prefix:
First Name:DANICA
Middle Name:DRUE
Last Name:BARNICLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 OCEAN RANCH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-8601
Mailing Address - Country:US
Mailing Address - Phone:760-967-4475
Mailing Address - Fax:
Practice Address - Street 1:1701 MISSION AVE STE 230
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7110
Practice Address - Country:US
Practice Address - Phone:760-712-3535
Practice Address - Fax:760-439-6901
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA92235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program