Provider Demographics
NPI:1952313074
Name:DAIL, LORI R
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:R
Last Name:DAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2462
Mailing Address - Country:US
Mailing Address - Phone:252-341-5007
Mailing Address - Fax:252-794-1851
Practice Address - Street 1:110 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2462
Practice Address - Country:US
Practice Address - Phone:252-341-5007
Practice Address - Fax:252-794-1851
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102939Medicaid