Provider Demographics
NPI:1114277027
Name:SIRIANO, MICHELLE (LCMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SIRIANO
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BAYSDEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8902
Mailing Address - Country:US
Mailing Address - Phone:412-552-0572
Mailing Address - Fax:
Practice Address - Street 1:715 GUM BRANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6427
Practice Address - Country:US
Practice Address - Phone:910-333-1031
Practice Address - Fax:910-333-1108
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11776101YM0800X
PAPC006485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1114277027OtherTRICARE
NC1114277027OtherBLUE CROSS BLUE SHIELD
NC1114277027OtherEMPLOYEE ASSISTANCE PROGRAM
NC1114277027OtherAETNA