Provider Demographics
NPI:1376979310
Name:CORK, DANIELLE LORENE (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LORENE
Last Name:CORK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:LORENE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:1201 ASBURY CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 LAPEER AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607
Practice Address - Country:US
Practice Address - Phone:989-759-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010998491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical