Provider Demographics
NPI:1457372245
Name:DANIELL, TRACEY A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:A
Last Name:DANIELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:T
Other - Last Name:ALDEWERELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35021-1462
Mailing Address - Country:US
Mailing Address - Phone:205-933-8101
Mailing Address - Fax:205-212-3951
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:2502
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:205-212-3951
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1883C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical