Healthcare Provider Details

I. General information

NPI: 1265312656
Provider Name (Legal Business Name): EVANGELINE DANENE SNELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 10/24/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

7725 SILVER VIEW LN
RALEIGH NC
27613-1456
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-4000
  • Fax:
Mailing address:
  • Phone: 919-470-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018642
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: