Provider Demographics
NPI:1336179266
Name:KNIFFEN, DAN ARTHUR (LCSW)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:ARTHUR
Last Name:KNIFFEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 E PARHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2760
Mailing Address - Country:US
Mailing Address - Phone:804-755-7323
Mailing Address - Fax:804-755-1215
Practice Address - Street 1:4100 E PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2760
Practice Address - Country:US
Practice Address - Phone:804-755-7323
Practice Address - Fax:804-755-1215
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040009311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008909920Medicaid
VA800000391Medicare UPIN