Individual
MR. KELVIN LORENZO MCDANIEL SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CEO
Contact information
Practice address
2811 TWAIN LN, NORTH CHESTERFIELD, VA 23224-4421
(804) 324-8686
(804) 324-8686
Mailing address
2811 TWAIN LN, NORTH CHESTERFIELD, VA 23224-4421
(804) 316-6234
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
VA
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
834152551
IRS
VA
Enumeration date
10/11/2017
Last updated
12/10/2019
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