Provider Demographics
NPI:1174133060
Name:DANIELS, MIRINDA (MA)
Entity type:Individual
Prefix:
First Name:MIRINDA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670-0655
Mailing Address - Country:US
Mailing Address - Phone:304-475-4561
Mailing Address - Fax:
Practice Address - Street 1:716 LEE ST E STE 201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1707
Practice Address - Country:US
Practice Address - Phone:304-784-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional