Basic Information
| Provider Information | |||||||||
| NPI: | 1932231891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | PANSY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, LCAS, CCS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES | ||||||||
| OtherFirstName: | PANSY | ||||||||
| OtherMiddleName: | DANIELS | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC, CACII | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 HIGHLAND AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271014180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366078523 | ||||||||
| FaxNumber: | 3367730914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1691 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | LPC004663 | GA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 10914 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 0690 | 01 | GA | CERT RISK RED PROG INSTRU | OTHER | 11841 | 01 | GA | SAP SUBSTANCE ABUSE PROF | OTHER | C-33801 | 01 | GA | CERT CLINICAL EVALUATOR | OTHER | 10914 | 01 | NC | LICENSED PROFESSIONAL COUNSELOR | OTHER | 1518 | 01 | GA | CACII CERT ADD COUNS II | OTHER | 467 | 01 | NC | CERTIFIED CLINICAL SUPERVISOR | OTHER | 1691 | 01 | NC | LICENSED CLINICIAL ADDICTION SPECIALIST | OTHER | 1932231891 | 05 | NC | MEDICAID | LPC004663 | 01 | GA | LICENSED PROFESSIONAL COUNSELOR | OTHER | T-34401 | 01 | GA | ASAM LEVEL I TX PROVIDER | OTHER |