Provider Demographics
NPI:1669491502
Name:DANIELSEN, IAN MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:MICHAEL
Last Name:DANIELSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E BROAD ST
Mailing Address - Street 2:SUITE LL40
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1928
Mailing Address - Country:US
Mailing Address - Phone:804-643-7226
Mailing Address - Fax:804-643-3529
Practice Address - Street 1:1001 E BROAD ST
Practice Address - Street 2:SUITE LL40
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1928
Practice Address - Country:US
Practice Address - Phone:804-643-7226
Practice Address - Fax:804-643-3529
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040058801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical