Healthcare Provider Details

I. General information

NPI: 1356003693
Provider Name (Legal Business Name): DANIELA FREDERICK LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 RIVERWOOD PKWY STE B
GASTONIA NC
28056-6002
US

IV. Provider business mailing address

200 E SECOND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-9005
  • Fax: 704-874-9001
Mailing address:
  • Phone: 704-874-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017499
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: