Provider Demographics
NPI:1043564271
Name:WAMSLEY, DANNY
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:WAMSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 TRIBUTE CENTER DR
Mailing Address - Street 2:APT 207
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3214
Mailing Address - Country:US
Mailing Address - Phone:919-917-3488
Mailing Address - Fax:
Practice Address - Street 1:1300 TRIBUTE CENTER DR
Practice Address - Street 2:APT 207
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3214
Practice Address - Country:US
Practice Address - Phone:919-917-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 103TA0400X
NC1007090103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)