Provider Demographics
NPI:1003411208
Name:DANIELS, LATOYA CAMP (MSW, LSCW-A)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:CAMP
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MSW, LSCW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3560
Mailing Address - Country:US
Mailing Address - Phone:704-880-7085
Mailing Address - Fax:
Practice Address - Street 1:363 WILLIAMSON RD STE 102
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5974
Practice Address - Country:US
Practice Address - Phone:704-664-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0145241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical