Provider Demographics
NPI:1366845430
Name:BAEZ, DANIELLE JUNE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JUNE
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 OLD TROLLEY RD STE 202B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4953
Mailing Address - Country:US
Mailing Address - Phone:854-206-5513
Mailing Address - Fax:854-423-3420
Practice Address - Street 1:89 OLD TROLLEY RD STE 202B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4953
Practice Address - Country:US
Practice Address - Phone:854-206-5513
Practice Address - Fax:854-246-8965
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC130221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical