Healthcare Provider Details

I. General information

NPI: 1881460723
Provider Name (Legal Business Name): YAZMYNE MCDANIEL LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MAYNARD LAKE RD
ERWIN NC
28339-8507
US

IV. Provider business mailing address

22 FALCONRIDGE DR
SPRING LAKE NC
28390-7192
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-8121
  • Fax:
Mailing address:
  • Phone: 336-575-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: