Healthcare Provider Details

I. General information

NPI: 1952120149
Provider Name (Legal Business Name): AYANNA MICHELLE GELLINEAU LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 WYNNEWOOD RD # U1
PHILADELPHIA PA
19151-3452
US

IV. Provider business mailing address

881 WYNNEWOOD RD # U1
PHILADELPHIA PA
19151-3452
US

V. Phone/Fax

Practice location:
  • Phone: 609-798-1597
  • Fax:
Mailing address:
  • Phone: 609-798-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017463
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: