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General NPI Number Information
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NPI Number | 1003411208
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Entity Type | Individual
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Provider Name | LATOYA CAMP DANIELS MSW, LSCW-A
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Gender | Female
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 363 WILLIAMSON RD STE 102
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City | MOORESVILLE
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State | NC
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Zip | 28117-5974
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Country | US
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Telephone | 704-664-7148
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 VALLEY ST
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City | STATESVILLE
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State | NC
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Zip | 28677-3560
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Country | US
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Telephone | 704-880-7085
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P014524
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License Number State | NC
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