MEDICARE: PACELLA COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1821805250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACELLA COUNSELING LLC

Provider Business Mailing Address
First Line	:	125 RIVERVIEW DR
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-2011
Country	:	US
Telephone Number	:	912-580-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2465 DEMERE RD STE 209
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-1630
Country	:	US
Telephone Number	:	912-580-0010
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GWEN PACELLA
Credential	:	LCSW
Telephone Number	:	912-580-0010

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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