Provider Demographics
NPI:1407229370
Name:STATELER, DANIELLE (MSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STATELER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 THOREAU DR
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-4299
Mailing Address - Country:US
Mailing Address - Phone:304-268-9797
Mailing Address - Fax:
Practice Address - Street 1:179 E BURR BLVD STE J
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-4964
Practice Address - Country:US
Practice Address - Phone:304-268-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP02943149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker