Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003075367 |
---|---|
Provider Name | Daniel Mariney |
First Address | Dacula, GA 30019-5016 |
Second Address | Flowery Branch, GA 30542-2921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 02/09/2020 |