Healthcare Provider Details

I. General information

NPI: 1659208585
Provider Name (Legal Business Name): ALYSSA NICOLE RACANELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VILLAGE RD
SHALLOTTE NC
28470-4441
US

IV. Provider business mailing address

1139 SPRING GLEN CT
LELAND NC
28451-9119
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-4097
  • Fax: 910-754-4907
Mailing address:
  • Phone: 631-560-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: