Provider Demographics
NPI:1679234595
Name:MATTINGLY, DANIELLE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GAY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3722
Mailing Address - Country:US
Mailing Address - Phone:317-489-7858
Mailing Address - Fax:
Practice Address - Street 1:305 GAY ST FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3722
Practice Address - Country:US
Practice Address - Phone:317-489-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013050101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor