Provider Demographics
NPI:1407318728
Name:DANIELS, TAWANNA L (LCPC)
Entity Type:Individual
Prefix:MS
First Name:TAWANNA
Middle Name:L
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 WASHINGTON BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3753
Mailing Address - Country:US
Mailing Address - Phone:708-218-8260
Mailing Address - Fax:
Practice Address - Street 1:215 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1533
Practice Address - Country:US
Practice Address - Phone:708-218-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional