Provider Demographics
NPI:1821517483
Name:DANIELS, CARLA (LSW)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PALMETTO PARK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7969
Mailing Address - Country:US
Mailing Address - Phone:803-399-9201
Mailing Address - Fax:803-808-5392
Practice Address - Street 1:3961 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-9038
Practice Address - Country:US
Practice Address - Phone:803-755-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health