Healthcare Provider Details

I. General information

NPI: 1053706671
Provider Name (Legal Business Name): DEANNA CUCCINELLO MA, LPCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ROLLING HILL RD STE 235
MOORESVILLE NC
28117-8855
US

IV. Provider business mailing address

171 BAYBERRY CREEK CIR
MOORESVILLE NC
28117-6690
US

V. Phone/Fax

Practice location:
  • Phone: 828-548-0313
  • Fax:
Mailing address:
  • Phone: 828-548-0313
  • Fax: 704-660-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA11370
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: