Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | L1113114 | MI |
Y | 1041C0700X | Clinical Social Worker | L1113114 | MI |
NPI | 1003108648 |
---|---|
Provider Name | Ms. Tawana Reena Daniel |
First Address | Livonia, MI 48153-0336 |
Second Address | Saline, MI 48176-9773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 21/06/2011 |