Provider Demographics
NPI:1710634324
Name:DANIELS, LITA JEANETTE
Entity Type:Individual
Prefix:
First Name:LITA
Middle Name:JEANETTE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 LORI DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4705
Mailing Address - Country:US
Mailing Address - Phone:267-226-1096
Mailing Address - Fax:
Practice Address - Street 1:2151 LORI DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4705
Practice Address - Country:US
Practice Address - Phone:267-226-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging