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General NPI Number Information
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NPI Number | 1114277027
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Entity Type | Individual
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Provider Name | MICHELLE SIRIANO LCMHC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 237 NEW RIVER DR STE 3
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5935
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Country | US
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Telephone | 910-333-1031
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Fax | 910-333-1108
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | JACKSONVILLE
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State | NC
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Zip | 28541-0007
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Country | US
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Telephone | 412-552-0572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC006485
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11776
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License Number State | NC
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