Provider Demographics
NPI:1649885906
Name:EDWARDS, DANIELLE MONIQUE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MONIQUE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MISSION CATALINA LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2711
Mailing Address - Country:US
Mailing Address - Phone:702-844-9930
Mailing Address - Fax:
Practice Address - Street 1:230 MISSION CATALINA LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2711
Practice Address - Country:US
Practice Address - Phone:702-844-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor