Provider Demographics
NPI:1639456296
Name:HERRERA, DAISY M (LPC, CAC)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:M
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LPC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CHATHAM PARK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-6189
Mailing Address - Country:US
Mailing Address - Phone:678-571-5958
Mailing Address - Fax:
Practice Address - Street 1:830 CHATHAM PARK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-6189
Practice Address - Country:US
Practice Address - Phone:678-571-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional