Provider Demographics
NPI:1871968867
Name:POOLE, DANIEL TIMOTHY (MS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:TIMOTHY
Last Name:POOLE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ROSWELL RD
Mailing Address - Street 2:APT 11C2
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3060
Mailing Address - Country:US
Mailing Address - Phone:352-789-9705
Mailing Address - Fax:
Practice Address - Street 1:1950 ROSWELL RD
Practice Address - Street 2:APT 11C2
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-3060
Practice Address - Country:US
Practice Address - Phone:352-789-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health