Individual
JACQUELINE DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1004 W 1ST ST, BLOOMINGTON, IN 47403-2208
(812) 668-2224
Mailing address
1004 W 1ST ST, BLOOMINGTON, IN 47403-2208
(812) 668-2224
(812) 532-2935
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
34005702A
IN
Other
Enumeration date
10/25/2006
Last updated
05/16/2019
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