Healthcare Provider Details

I. General information

NPI: 1023355815
Provider Name (Legal Business Name): DANIELLE YVONNE FAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE YVONNE THOMSON LCSWA

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W WALKER AVE
ASHEBORO NC
27203-6760
US

IV. Provider business mailing address

3037 PISGAH PL APT C
GREENSBORO NC
27455-3267
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-7000
  • Fax:
Mailing address:
  • Phone: 336-448-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP005841
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009029
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: