Provider Demographics
NPI:1679345599
Name:DECROIX, DANIELLE (LMBT NC17092)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DECROIX
Suffix:
Gender:F
Credentials:LMBT NC17092
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 FLINT HILL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NC
Mailing Address - Zip Code:28701-9656
Mailing Address - Country:US
Mailing Address - Phone:217-416-9921
Mailing Address - Fax:
Practice Address - Street 1:263 HAYWOOD ST STE 102
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2629
Practice Address - Country:US
Practice Address - Phone:828-263-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17092225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist