Provider Demographics
NPI:1033702634
Name:CARR, DANIELLE SHERIE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHERIE
Last Name:CARR
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3186 AIRWAY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4650
Mailing Address - Country:US
Mailing Address - Phone:714-881-0427
Mailing Address - Fax:714-327-0673
Practice Address - Street 1:5400 KEARNY MESA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1303
Practice Address - Country:US
Practice Address - Phone:619-717-2363
Practice Address - Fax:714-327-0673
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 172V00000X
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker