Provider Demographics
NPI:1659034692
Name:MCDANIEL, CASEY (LPC, ATR-P)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LPC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 CLAIBORNE SQ E STE 211
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2071
Mailing Address - Country:US
Mailing Address - Phone:757-977-0889
Mailing Address - Fax:
Practice Address - Street 1:555 E MAIN ST STE 1100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2232
Practice Address - Country:US
Practice Address - Phone:757-977-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional