Provider Demographics
NPI:1700205671
Name:COLEMAN DYKES, DANIELLE SHAWNTEA (LCSW, DAAC,MD,DPHD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SHAWNTEA
Last Name:COLEMAN DYKES
Suffix:
Gender:F
Credentials:LCSW, DAAC,MD,DPHD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:S
Other - Last Name:COLEMAN DYKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:53 COLTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1247
Mailing Address - Country:US
Mailing Address - Phone:415-477-1912
Mailing Address - Fax:
Practice Address - Street 1:53 COLTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1247
Practice Address - Country:US
Practice Address - Phone:415-477-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99816171M00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19817999Medicaid
CA0009-0006-3808-5152OtherORCID
CAQ69LQNEU2MM7OtherUEI