Healthcare Provider Details

I. General information

NPI: 1043564271
Provider Name (Legal Business Name): DANNY WAMSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 TRIBUTE CENTER DR APT 207
RALEIGH NC
27612-3214
US

IV. Provider business mailing address

1300 TRIBUTE CENTER DR APT 207
RALEIGH NC
27612-3214
US

V. Phone/Fax

Practice location:
  • Phone: 919-917-3488
  • Fax:
Mailing address:
  • Phone: 919-917-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1007090
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: