Provider Demographics
NPI:1679859722
Name:DANIELS, SHAUNA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 JACKSON ST STE F
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2656
Mailing Address - Country:US
Mailing Address - Phone:252-308-0744
Mailing Address - Fax:252-308-0744
Practice Address - Street 1:608 JACKSON ST STE F
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2656
Practice Address - Country:US
Practice Address - Phone:252-308-0744
Practice Address - Fax:252-308-0744
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ40007AOtherMEDICARE PROVIDER NUMBER
NC6009135Medicaid