Provider Demographics
NPI:1538591193
Name:DAW, JANAE DANIELLE
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:DANIELLE
Last Name:DAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1861
Mailing Address - Country:US
Mailing Address - Phone:707-269-2003
Mailing Address - Fax:707-442-0110
Practice Address - Street 1:537 9TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1861
Practice Address - Country:US
Practice Address - Phone:707-269-2003
Practice Address - Fax:707-442-0110
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA96359101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator