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General NPI Number Information
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NPI Number | 1275773749
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Entity Type | Individual
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Provider Name | MICHELLE ANN DATTADA MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 5878 FARINGDON PL
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City | RALEIGH
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State | NC
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Zip | 27609-4589
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Country | US
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Telephone | 919-872-4833
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Fax |
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Provider Business Mailing Address
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Address Line | 5878 FARINGDON PL
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City | RALEIGH
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State | NC
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Zip | 27609-4589
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Country | US
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Telephone | 919-872-4833
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | P004806
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33SL05490100
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License Number State | NJ
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