Provider Demographics
NPI:1134534977
Name:SMITH-DANIELS, LUWANDA
Entity type:Individual
Prefix:
First Name:LUWANDA
Middle Name:
Last Name:SMITH-DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUWANDA
Other - Middle Name:DENISE
Other - Last Name:SMITH-DANIELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:3201 CHERRYDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5438
Mailing Address - Country:US
Mailing Address - Phone:336-370-9400
Mailing Address - Fax:
Practice Address - Street 1:157 BLUE BELL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5301
Practice Address - Country:US
Practice Address - Phone:336-370-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603579Medicaid