Provider Demographics
NPI:1972106755
Name:DANIELS, ERICA CORPENING (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:CORPENING
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3560
Mailing Address - Country:US
Mailing Address - Phone:336-528-4042
Mailing Address - Fax:
Practice Address - Street 1:1174 VALLEY ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3560
Practice Address - Country:US
Practice Address - Phone:336-528-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty