Provider Demographics
NPI:1699517581
Name:BASS, DANIELLE (LCSWA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 WICKER ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4151
Practice Address - Country:US
Practice Address - Phone:919-292-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP020695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty