Healthcare Provider Details

I. General information

NPI: 1073123238
Provider Name (Legal Business Name): DANIELLE SIBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 HEATHROW DR
SPRING LAKE NC
28390-9266
US

IV. Provider business mailing address

378 HEATHROW DR
SPRING LAKE NC
28390-9266
US

V. Phone/Fax

Practice location:
  • Phone: 912-228-1027
  • Fax:
Mailing address:
  • Phone: 912-228-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014175
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: