Basic Information
| Provider Information | |||||||||
| NPI: | 1023399193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99613 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921691613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195673090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4060 FAIRMOUNT AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195841612 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2011 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 27264 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 27264 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041S0200X | 27264 | CA | N | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.