Provider Demographics
NPI:1760608640
Name:MABUS, DANIEL A
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:MABUS
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 1:112 PAINTER ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-3828
Mailing Address - Country:US
Mailing Address - Phone:276-236-2994
Mailing Address - Fax:276-238-8762
Practice Address - Street 1:112 PAINTER ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3828
Practice Address - Country:US
Practice Address - Phone:276-236-2994
Practice Address - Fax:276-238-8762
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)