Provider Demographics
NPI:1588800197
Name:DANIEL, ALISA S (LCSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:S
Last Name:DANIEL
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 1:17342 ARROWWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-2487
Mailing Address - Country:US
Mailing Address - Phone:540-338-8109
Mailing Address - Fax:
Practice Address - Street 1:621 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3012
Practice Address - Country:US
Practice Address - Phone:540-338-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical