Provider Demographics
NPI:1053317289
Name:DANIEL, ANN T (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:T
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 FLORIDA PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9163
Mailing Address - Country:US
Mailing Address - Phone:252-725-0022
Mailing Address - Fax:
Practice Address - Street 1:1104 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4144
Practice Address - Country:US
Practice Address - Phone:252-725-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102359Medicaid