Provider Demographics
NPI:1558971333
Name:TAIN, DANIELLE C
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:TAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 TWELVE OAKS PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-4432
Mailing Address - Country:US
Mailing Address - Phone:704-577-7163
Mailing Address - Fax:
Practice Address - Street 1:3443 TWELVE OAKS PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-4432
Practice Address - Country:US
Practice Address - Phone:704-577-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician