Provider Demographics
NPI:1467069781
Name:FLORES, DANIELLE (LGPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 GATEWATER CT
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7177
Mailing Address - Country:US
Mailing Address - Phone:443-956-0953
Mailing Address - Fax:
Practice Address - Street 1:337 GATEWATER CT APT 203
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7389
Practice Address - Country:US
Practice Address - Phone:443-956-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty