Provider Demographics
NPI:1467555201
Name:MCDANIEL, KIMBERLY DANIELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6538 PALACE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7977
Mailing Address - Country:US
Mailing Address - Phone:901-381-2777
Mailing Address - Fax:
Practice Address - Street 1:6560 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3656
Practice Address - Country:US
Practice Address - Phone:901-767-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1829-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X967Medicare UPIN