Provider Demographics
NPI:1497329379
Name:BROLIN, DAITON STONE (LCSWA)
Entity type:Individual
Prefix:
First Name:DAITON
Middle Name:STONE
Last Name:BROLIN
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:DAITON
Other - Middle Name:STONE
Other - Last Name:BROLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:7406 CHAPEL HILL RD STE J
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5039
Mailing Address - Country:US
Mailing Address - Phone:910-494-8486
Mailing Address - Fax:919-573-0438
Practice Address - Street 1:7330 CHAPEL HILL RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5042
Practice Address - Country:US
Practice Address - Phone:910-494-8486
Practice Address - Fax:919-673-0438
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0208411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical