Provider Demographics
NPI:1619384260
Name:DANIELSON, DEBORAH LEAH
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEAH
Last Name:DANIELSON
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 1:2303 FORT WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1665
Mailing Address - Country:US
Mailing Address - Phone:301-642-0352
Mailing Address - Fax:
Practice Address - Street 1:2303 FORT WILLIAM DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1665
Practice Address - Country:US
Practice Address - Phone:301-642-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional