Provider Demographics
NPI:1972734390
Name:MCDANIEL, ANNETTE (NCC CCMHC LMHC LMT)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:NCC CCMHC LMHC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100156
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32910-0156
Mailing Address - Country:US
Mailing Address - Phone:321-272-5996
Mailing Address - Fax:
Practice Address - Street 1:665 DILLARD DR SE
Practice Address - Street 2:VIRTUAL/ONLINE ONLY
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909
Practice Address - Country:US
Practice Address - Phone:321-272-5996
Practice Address - Fax:321-473-8874
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
TX69138101YP2500X
NC7677101YP2500X
FLMH15855101YM0800X
FLMA86130225700000X
TXMT127516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112121Medicaid