Provider Demographics
NPI:1972780740
Name:SIEGRIST, DANIELLE PAIGE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PAIGE
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:PAIGE
Other - Last Name:KEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:163 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8017
Mailing Address - Country:US
Mailing Address - Phone:757-338-3773
Mailing Address - Fax:
Practice Address - Street 1:1801 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-6323
Practice Address - Country:US
Practice Address - Phone:757-398-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903001429104100000X
TX37783104100000X
VA09040067621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker