Provider Demographics
NPI:1659109833
Name:DANIEL, ANDREW WHITTEMORE (LCMHCA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WHITTEMORE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:MR
Other - First Name:WHITT
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:235 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5305
Mailing Address - Country:US
Mailing Address - Phone:336-355-8084
Mailing Address - Fax:
Practice Address - Street 1:21024 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8585
Practice Address - Country:US
Practice Address - Phone:336-355-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty