Provider Demographics
NPI:1639262207
Name:YORK, DANIEL C
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:YORK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-2728
Mailing Address - Country:US
Mailing Address - Phone:703-307-2721
Mailing Address - Fax:
Practice Address - Street 1:413 WASHINGTON GROVE LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1182
Practice Address - Country:US
Practice Address - Phone:301-258-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003032103TC0700X
MD01919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD652901100Medicaid
VA010253829Medicaid