Provider Demographics
NPI:1417406224
Name:DAN A KNIFFEN LCSW LLC
Entity Type:Organization
Organization Name:DAN A KNIFFEN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNIFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-755-7323
Mailing Address - Street 1:4100 EAST PARHAM ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228
Mailing Address - Country:US
Mailing Address - Phone:804-755-7323
Mailing Address - Fax:804-755-1215
Practice Address - Street 1:4100 EAST PARHAM ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228
Practice Address - Country:US
Practice Address - Phone:804-755-7323
Practice Address - Fax:804-755-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8909920Medicaid
800000391Medicare UPIN