Provider Demographics
NPI:1639711005
Name:LANDA, DANIELLE D (LAMFT, LADC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:D
Last Name:LANDA
Suffix:
Gender:F
Credentials:LAMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 E RIVER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1891
Mailing Address - Country:US
Mailing Address - Phone:763-427-1950
Mailing Address - Fax:763-427-7006
Practice Address - Street 1:646 E RIVER RD STE 1
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1891
Practice Address - Country:US
Practice Address - Phone:763-427-1950
Practice Address - Fax:763-427-7006
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health