Provider Demographics
NPI:1750309753
Name:DANIELS, ANITA ANTOINETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:ANTOINETTE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:ANTOINETTE
Other - Last Name:DANIELS-KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:102 NUTTREE WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9079
Mailing Address - Country:US
Mailing Address - Phone:919-403-6900
Mailing Address - Fax:
Practice Address - Street 1:2609 N DUKE ST STE 900
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3019
Practice Address - Country:US
Practice Address - Phone:919-313-0260
Practice Address - Fax:919-313-0299
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342249Medicare ID - Type UnspecifiedGROUP #