Provider Demographics
NPI:1538208921
Name:MCDANIEL, GEORGIA E (MA)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:E
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PORTOLA DR
Mailing Address - Street 2:#9
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1587
Mailing Address - Country:US
Mailing Address - Phone:415-285-3355
Mailing Address - Fax:
Practice Address - Street 1:3501 LONE TREE WAY
Practice Address - Street 2:200
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6066
Practice Address - Country:US
Practice Address - Phone:925-427-8664
Practice Address - Fax:925-427-8645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF45332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist