Healthcare Provider Details

I. General information

NPI: 1841739844
Provider Name (Legal Business Name): DENI URDA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 11/12/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 WESTGATE DR STE 303
DURHAM NC
27707-2534
US

IV. Provider business mailing address

3622 LYCKAN PKWY STE 4008
DURHAM NC
27707-2539
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-0225
  • Fax: 919-869-1467
Mailing address:
  • Phone: 919-213-0225
  • Fax: 919-869-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: