Provider Demographics
NPI:1750849105
Name:LOFTIS, DANIEL C (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:C
Last Name:LOFTIS
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-5505
Mailing Address - Country:US
Mailing Address - Phone:321-292-4528
Mailing Address - Fax:
Practice Address - Street 1:1600 E ROBINSON ST STE 250
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5955
Practice Address - Country:US
Practice Address - Phone:407-423-3327
Practice Address - Fax:401-843-1860
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH18715OtherSTATE OF FLORIDA, DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE