Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 831 | SC |
Y | 103T00000X | Psychologist | 831 | SC |
N | 102L00000X | Psychologist | PSY002223 | GA |
N | 103T00000X | Psychologist | PSY002223 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY002223 | GA |
N | 103G00000X | Clinical Psychologist | PSY002223 | GA |
N | 103TC0700X | Clinical Psychologist | PSY002223 | GA |
N | 103TF0000X | Family Psychologist | PSY002223 | GA |
NPI | 1104849215 |
---|---|
Provider Name | Dr. Larry E Daniels |
First Address | Augusta, GA 30904-6219 |
Second Address | Augusta, GA 30904-6219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 01/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000801094C | (05) | GA |
861 | (02) | SC |
PS0268 | (05) | SC |
PSY002223 | (02) | GA |