Basic Information
| Provider Information | |||||||||
| NPI: | 1023355815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAY | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | YVONNE | ||||||||
| NamePrefix: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMSON | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | YVONNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LCSWA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3037 PISGAH PL APT C | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274553267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364488802 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 W WALKER AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272036760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366337000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2013 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P005841 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C009029 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.