Provider Demographics
NPI:1881306322
Name:CHILDERS, DANIELA (MED, EDS, RMHCI)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MED, EDS, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 NW 36TH RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2105
Mailing Address - Country:US
Mailing Address - Phone:561-254-1267
Mailing Address - Fax:
Practice Address - Street 1:3463 NW 13TH ST STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2172
Practice Address - Country:US
Practice Address - Phone:352-562-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health