Provider Demographics
NPI:1750840765
Name:TWIFORD, DANIEL TREY
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TREY
Last Name:TWIFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2195
Mailing Address - Country:US
Mailing Address - Phone:770-703-4726
Mailing Address - Fax:
Practice Address - Street 1:110 SERENITY LN
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7086
Practice Address - Country:US
Practice Address - Phone:770-880-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012899101YP2500X
LA1315106H00000X
GAMFT001690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional