Provider Demographics
NPI:1023355815
Name:FAY, DANIELLE YVONNE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:YVONNE
Last Name:FAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:YVONNE
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA
Mailing Address - Street 1:3037 PISGAH PL APT C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3267
Mailing Address - Country:US
Mailing Address - Phone:336-448-8802
Mailing Address - Fax:
Practice Address - Street 1:110 W WALKER AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6760
Practice Address - Country:US
Practice Address - Phone:336-633-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0058411041C0700X
NCC0090291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical