Individual
DANIEL BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCMHCA
Contact information
Practice address
4730 PARK RD STE A, CHARLOTTE, NC 28209-4205
(704) 800-4436
Mailing address
831 JACKSON ST, GASTONIA, NC 28052-7555
(704) 860-1211
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A20266
NC
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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