Individual
CLOVIS EVERET DALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
17102 EAGLE HARBOR RD, AQUASCO, MD 20608-9566
(301) 266-0340
Mailing address
17102 EAGLE HARBOR RD, AQUASCO, MD 20608-9566
(301) 266-0340
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
LC50079299
DC
Other
Enumeration date
02/10/2012
Last updated
02/10/2012
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