Basic Information
| Provider Information | |||||||||
| NPI: | 1659547230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIANCIULLI | ||||||||
| FirstName: | CELESTE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1409 PINCKNEY ST | ||||||||
| Address2: | WHITEVILLE | ||||||||
| City: | WHITEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284722220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106410600 | ||||||||
| FaxNumber: | 2524130932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 S 17TH ST | ||||||||
| Address2: | WILMINGTON | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107919625 | ||||||||
| FaxNumber: | 2526383742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 11/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 290 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | C003406 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6106950 | 05 | NC | MEDICAID |