Provider Demographics
NPI:1679028211
Name:DANCE, DANIELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:DANCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5837 BRICKELL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-3501
Mailing Address - Country:US
Mailing Address - Phone:954-235-9277
Mailing Address - Fax:
Practice Address - Street 1:13565 AMERICAN COLONY BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-5681
Practice Address - Country:US
Practice Address - Phone:470-779-7709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical