Provider Demographics
NPI:1013774546
Name:DANIELS, TRICIA DIANN (CLINICAL SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:DIANN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CLINICAL SPECIALIST
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1504 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2918
Mailing Address - Country:US
Mailing Address - Phone:517-648-3381
Mailing Address - Fax:
Practice Address - Street 1:419 N MLK BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1856
Practice Address - Country:US
Practice Address - Phone:517-887-0226
Practice Address - Fax:517-887-8121
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)