Provider Demographics
NPI:1366000416
Name:DANIELS HARBOR THERAPY CENTER LLC
Entity Type:Organization
Organization Name:DANIELS HARBOR THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIESIA
Authorized Official - Middle Name:DESHAE
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-780-3496
Mailing Address - Street 1:1754 SEA LARK LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7406
Mailing Address - Country:US
Mailing Address - Phone:850-780-3496
Mailing Address - Fax:850-462-2094
Practice Address - Street 1:1754 SEA LARK LN
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7406
Practice Address - Country:US
Practice Address - Phone:850-780-3496
Practice Address - Fax:850-462-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty