Provider Demographics
NPI:1750333852
Name:THOMAS E. MCDANIEL, LCSW INC.
Entity type:Organization
Organization Name:THOMAS E. MCDANIEL, LCSW INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-929-8712
Mailing Address - Street 1:PO BOX 2307
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-2307
Mailing Address - Country:US
Mailing Address - Phone:704-929-8712
Mailing Address - Fax:
Practice Address - Street 1:276 OLD MOCKSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1949
Practice Address - Country:US
Practice Address - Phone:704-929-8712
Practice Address - Fax:704-883-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952OtherCBHA
2047394OtherCIGNA BHAVIORAL HLTH
NC126C0OtherBLUE CROSS BLUE SHIELD NC
94892OtherMEDCOST
112075OtherUNITED BHAVIORAL HLTHCARE
GRP 358961 PIN366949OtherMANAGE HLTH NETWORK
253003OtherCOMPSYCH
358961OtherTRICARE
GRP 358961 PIN366949OtherMANAGE HLTH NETWORK
1952OtherCBHA
GRP 358961 PIN366949OtherMANAGE HLTH NETWORK