Provider Demographics
NPI:1871626697
Name:DANIELS, CYNTHIA (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 YANCEYVILLE ST
Mailing Address - Street 2:APT M
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-2568
Mailing Address - Country:US
Mailing Address - Phone:336-333-6853
Mailing Address - Fax:336-333-6815
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2957
Practice Address - Country:US
Practice Address - Phone:336-333-6853
Practice Address - Fax:336-333-6815
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102290Medicaid