Provider Demographics
NPI:1710980008
Name:O'SHIELDS, DANIEL L (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:O'SHIELDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-2838
Mailing Address - Country:US
Mailing Address - Phone:864-427-1601
Mailing Address - Fax:
Practice Address - Street 1:323 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2838
Practice Address - Country:US
Practice Address - Phone:864-427-1601
Practice Address - Fax:864-427-1605
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional