Provider Demographics
NPI:1649735994
Name:MCDANIEL, JOSEPH JR (MED, MBA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MCDANIEL
Suffix:JR
Gender:M
Credentials:MED, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7503
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-3095
Mailing Address - Country:US
Mailing Address - Phone:910-674-9271
Mailing Address - Fax:
Practice Address - Street 1:221 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5647
Practice Address - Country:US
Practice Address - Phone:910-674-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral