Provider Demographics
NPI:1013491398
Name:BEHRENS, DANIELLE RAE (LCPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAE
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CHIPPINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 CHIPPINGWOOD DR
Practice Address - Street 2:
Practice Address - City:PORT REPUBLIC
Practice Address - State:MD
Practice Address - Zip Code:20676-2140
Practice Address - Country:US
Practice Address - Phone:480-335-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health