Provider Demographics
NPI:1053682815
Name:DANIELS, MICHAEL NA (LCAS LCSW CCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NA
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LCAS LCSW CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WINTER COURT
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576
Mailing Address - Country:US
Mailing Address - Phone:919-300-9338
Mailing Address - Fax:
Practice Address - Street 1:2604 WINDING CV
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-8611
Practice Address - Country:US
Practice Address - Phone:919-300-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1593101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)