Provider Demographics
NPI:1366001695
Name:DANIEL, HOLTON ARIEL
Entity Type:Individual
Prefix:
First Name:HOLTON
Middle Name:ARIEL
Last Name:DANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLTON
Other - Middle Name:ARIEL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-0009
Mailing Address - Country:US
Mailing Address - Phone:434-594-6692
Mailing Address - Fax:
Practice Address - Street 1:233 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1807
Practice Address - Country:US
Practice Address - Phone:434-532-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health