Provider Demographics
NPI:1770261653
Name:DAIEN, DANIELLE NICOLE (MA LLC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:DAIEN
Suffix:
Gender:F
Credentials:MA LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 AVALON CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2081
Mailing Address - Country:US
Mailing Address - Phone:248-292-1749
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD STE 60
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1729
Practice Address - Country:US
Practice Address - Phone:248-608-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023089101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor