Healthcare Provider Details

I. General information

NPI: 1104472398
Provider Name (Legal Business Name): YARENI DE ANDA DRAKE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 LAWNDALE DR STE E2
GREENSBORO NC
27455-1641
US

IV. Provider business mailing address

3817 LAWNDALE DR STE E2
GREENSBORO NC
27455-1641
US

V. Phone/Fax

Practice location:
  • Phone: 336-355-7872
  • Fax: 336-223-6437
Mailing address:
  • Phone: 336-355-7872
  • Fax: 336-223-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106802
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: