Healthcare Provider Details

I. General information

NPI: 1659546646
Provider Name (Legal Business Name): DANIELLE NICOLE WUNKER CRC, LPC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 COMMERCE ST SUITE B
GREENVILLE NC
27858-5032
US

IV. Provider business mailing address

223 COMMERCE ST SUITE B
GREENVILLE NC
27858-5032
US

V. Phone/Fax

Practice location:
  • Phone: 252-215-9195
  • Fax: 252-215-9196
Mailing address:
  • Phone: 252-215-9195
  • Fax: 252-215-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7173
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: