Provider Demographics
NPI:1225348675
Name:PANNELL, KERI GENISE (LPC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:KERI
Middle Name:GENISE
Last Name:PANNELL
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NAVAHO DR
Mailing Address - Street 2:SUITE 125-126
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7319
Mailing Address - Country:US
Mailing Address - Phone:919-431-9874
Mailing Address - Fax:919-431-9875
Practice Address - Street 1:1100 NAVAHO DR
Practice Address - Street 2:SUITE 125
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7319
Practice Address - Country:US
Practice Address - Phone:919-431-9874
Practice Address - Fax:919-431-9875
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101YP2500X
NC8192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health