Provider Demographics
NPI:1871152389
Name:HERNANDEZ, LUIS DANIEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:DANIEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 KITTRELL FARMS DR # T-8
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8151
Mailing Address - Country:US
Mailing Address - Phone:919-273-0506
Mailing Address - Fax:
Practice Address - Street 1:1819 PEACHTREE RD NE STE 450
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1853
Practice Address - Country:US
Practice Address - Phone:910-332-5734
Practice Address - Fax:910-332-5739
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0134491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical