| Organization Name: | MICHELLE DATTADA, LCSW, PLLC |
| NPI Number: | 1134488836 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELLE ANN DATTADA (OWNER) |
| Mailing Address: | 992 Durham Rd Ste A Wake Forest |
| State: | NC US |
| Postal Code: | 275876590 |
| Phone Number: | 7324853956 |
| Fax Number: | |
| NPI Enumeration Date: | 05/15/2012 |
| NPI Last Update Date: | 05/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C007061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |