Provider Demographics
NPI:1992032759
Name:CRANDELL, DANIEL LEROY JR (MA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEROY
Last Name:CRANDELL
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2511 NEUDORF RD
Mailing Address - Street 2:D
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8993
Mailing Address - Country:US
Mailing Address - Phone:336-778-0506
Mailing Address - Fax:336-778-0570
Practice Address - Street 1:2511 NEUDORF RD
Practice Address - Street 2:D
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8993
Practice Address - Country:US
Practice Address - Phone:336-778-0506
Practice Address - Fax:336-778-0570
Is Sole Proprietor?:No
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist