Provider Demographics
NPI:1730835885
Name:DANIELS, MARK (LGSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MAINE AVE SW # E821
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3447
Mailing Address - Country:US
Mailing Address - Phone:202-520-9496
Mailing Address - Fax:
Practice Address - Street 1:950 MAINE AVE SW # E821
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3447
Practice Address - Country:US
Practice Address - Phone:202-520-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200001345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker