Provider Demographics
NPI:1134957491
Name:BAKSIC, DANIELLE L (MS, LMHC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:BAKSIC
Suffix:
Gender:
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LYNN
Other - Last Name:DEPACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-1114 WAIHOANO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6299
Mailing Address - Country:US
Mailing Address - Phone:210-387-9792
Mailing Address - Fax:
Practice Address - Street 1:99-149 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4001
Practice Address - Country:US
Practice Address - Phone:808-909-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIMHC-1108-0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program