Provider Demographics
NPI:1053730200
Name:DANIEL, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:DANIEL
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 1:668 GLENBARRETT CT NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8511
Mailing Address - Country:US
Mailing Address - Phone:770-337-8921
Mailing Address - Fax:
Practice Address - Street 1:366 POWDER SPRINGS ST STE 204
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3424
Practice Address - Country:US
Practice Address - Phone:770-337-8921
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0048601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical