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General NPI Number Information
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NPI Number | 1053560730
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Entity Type | Individual
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Provider Name | VANESSA DANIELL LADRIE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 04/24/2011
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Provider Practice Location Address
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Address Line | 8400 SIX FORKS RD SUITE 203
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City | RALEIGH
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State | NC
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Zip | 27615-3068
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Country | US
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Telephone | 919-452-5202
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 LAGERFELD WAY
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City | WAKE FOREST
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State | NC
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Zip | 27587-1643
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Country | US
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Telephone | 919-452-5202
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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 | C006156
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License Number State | NC
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