Provider Demographics
NPI:1578549853
Name:NELLIGAN, SEAN PATRICK (LCSW, ACSW,)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PATRICK
Last Name:NELLIGAN
Suffix:
Gender:M
Credentials:LCSW, ACSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 LA VALE CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9009
Mailing Address - Country:US
Mailing Address - Phone:336-817-3396
Mailing Address - Fax:336-217-8809
Practice Address - Street 1:3410 HEALY DR
Practice Address - Street 2:STE. 202
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1403
Practice Address - Country:US
Practice Address - Phone:336-817-3396
Practice Address - Fax:336-217-8809
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002239Medicaid
NC5858KOtherBLUE CROSS/BLUE SHIELD
NC5858KOtherBLUE CROSS/BLUE SHIELD
NCNCMC001590OtherVALUE OPTIONS