Provider Demographics
NPI:1447338462
Name:DANIELS, CAROL JEAN (PHD LMFT)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W. LOMBARD STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1701
Mailing Address - Country:US
Mailing Address - Phone:563-324-9050
Mailing Address - Fax:563-424-7827
Practice Address - Street 1:1333 W. LOMBARD STREET SUITE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1701
Practice Address - Country:US
Practice Address - Phone:563-324-9050
Practice Address - Fax:563-424-7827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000570106H00000X
IA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist