Provider Demographics
NPI:1649890823
Name:POE, DANIELLE LASHA (OCPS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LASHA
Last Name:POE
Suffix:
Gender:F
Credentials:OCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1143
Mailing Address - Country:US
Mailing Address - Phone:937-544-5547
Mailing Address - Fax:937-544-3935
Practice Address - Street 1:923 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1143
Practice Address - Country:US
Practice Address - Phone:937-544-5547
Practice Address - Fax:937-544-3035
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161359405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional