Provider Demographics
NPI:1922159276
Name:DAVIS, DANIELLE L
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 ONIX DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1886
Mailing Address - Country:US
Mailing Address - Phone:484-731-2500
Mailing Address - Fax:
Practice Address - Street 1:263 QUIGLEY BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:HISTORIC NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-8112
Practice Address - Country:US
Practice Address - Phone:302-323-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040691Medicaid