Provider Demographics
NPI:1265770788
Name:LAYCOOK, DANIELLE CHRISTINA
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:CHRISTINA
Last Name:LAYCOOK
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 1:3450 EMERALD ST
Mailing Address - Street 2:15
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3723
Mailing Address - Country:US
Mailing Address - Phone:805-907-6555
Mailing Address - Fax:
Practice Address - Street 1:637 E ALBERTONI ST
Practice Address - Street 2:109
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1539
Practice Address - Country:US
Practice Address - Phone:310-532-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)