Provider Demographics
NPI:1982298063
Name:BANNERMAN, DARIA MICHELLE (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:MICHELLE
Last Name:BANNERMAN
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 COLONIAL CV
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2206
Mailing Address - Country:US
Mailing Address - Phone:910-231-9115
Mailing Address - Fax:
Practice Address - Street 1:3656 COLONIAL CV
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2206
Practice Address - Country:US
Practice Address - Phone:910-231-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP013313101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor