Provider Demographics
NPI:1639618952
Name:MCDANIEL, MICHELLE ADAMS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ADAMS
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 1:2 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7076
Mailing Address - Country:US
Mailing Address - Phone:505-818-8253
Mailing Address - Fax:505-521-5150
Practice Address - Street 1:2 MORGAN RD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7076
Practice Address - Country:US
Practice Address - Phone:505-818-8253
Practice Address - Fax:505-521-5150
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-091981041C0700X
NMC-102431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical