Provider Demographics
NPI:1669681805
Name:DALEY, GRACE L (M S, CAP)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:L
Last Name:DALEY
Suffix:
Gender:F
Credentials:M S, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 ADRIAN AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1618
Mailing Address - Country:US
Mailing Address - Phone:727-581-2871
Mailing Address - Fax:727-581-2871
Practice Address - Street 1:2508 ADRIAN AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1618
Practice Address - Country:US
Practice Address - Phone:727-581-2871
Practice Address - Fax:727-581-2871
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP1603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)