Provider Demographics
NPI:1659864528
Name:MCINTYRE, DANELLA DENISE (LCSW-QS, DSW CAND)
Entity Type:Individual
Prefix:
First Name:DANELLA
Middle Name:DENISE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSW-QS, DSW CAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 DUVAL STATION ROAD, SUITE 107-231
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8331
Mailing Address - Country:US
Mailing Address - Phone:904-496-2962
Mailing Address - Fax:904-431-3554
Practice Address - Street 1:731 DUVAL STATION ROAD, SUITE 107-231
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8331
Practice Address - Country:US
Practice Address - Phone:904-496-2962
Practice Address - Fax:904-431-3554
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW151621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical