Provider Demographics
NPI:1881412880
Name:DANIELS, ESI
Entity type:Individual
Prefix:
First Name:ESI
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 COUNSELORS WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8656
Mailing Address - Country:US
Mailing Address - Phone:571-340-1304
Mailing Address - Fax:
Practice Address - Street 1:322 COUNSELORS WAY APT 103
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8656
Practice Address - Country:US
Practice Address - Phone:571-340-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040173351041C0700X
SC173021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical