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General NPI Number Information
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NPI Number | 1659702249
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Entity Type | Individual
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Provider Name | TAWANNA KEOLA DANIEL
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Gender | Female
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 404 PALADIN DR APT N
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City | GREENVILLE
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State | NC
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Zip | 27834-7864
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Country | US
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Telephone | 252-469-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 W VANCROFT CIR APT 3
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City | WINTERVILLE
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State | NC
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Zip | 28590-8086
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Country | US
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Telephone | 252-885-4370
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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 | P007439
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P015985
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License Number State | NC
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