Provider Demographics
NPI:1689011363
Name:MCDANIEL, AGNES MARIA (CAC II)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:MARIA
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 FURMAN FIELD RD
Mailing Address - Street 2:
Mailing Address - City:REMBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29128-9156
Mailing Address - Country:US
Mailing Address - Phone:808-983-8277
Mailing Address - Fax:
Practice Address - Street 1:4380 FURMAN FIELD RD
Practice Address - Street 2:
Practice Address - City:REMBERT
Practice Address - State:SC
Practice Address - Zip Code:29128
Practice Address - Country:US
Practice Address - Phone:808-983-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD18SUMedicaid