Provider Demographics
NPI:1770882938
Name:DESNOYERS, DANIELLE (MED, LPC, RPT-S)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DESNOYERS
Suffix:
Gender:F
Credentials:MED, LPC, RPT-S
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:DESNOYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC, RPT-S
Mailing Address - Street 1:1201 CLAIRMONT RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1258
Mailing Address - Country:US
Mailing Address - Phone:404-348-3250
Mailing Address - Fax:
Practice Address - Street 1:1201 CLAIRMONT RD
Practice Address - Street 2:SUITE 305
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1258
Practice Address - Country:US
Practice Address - Phone:404-348-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional