Provider Demographics
NPI:1245716877
Name:STIVERS, DANIELLE (LCPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STIVERS
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 1:5172 VIADUCT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-4237
Mailing Address - Country:US
Mailing Address - Phone:410-207-7741
Mailing Address - Fax:
Practice Address - Street 1:5172 VIADUCT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-4237
Practice Address - Country:US
Practice Address - Phone:410-207-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health