Provider Demographics
NPI:1659547230
Name:CIANCIULLI, CELESTE M (LCSW)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:M
Last Name:CIANCIULLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 PINCKNEY ST
Mailing Address - Street 2:WHITEVILLE
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2220
Mailing Address - Country:US
Mailing Address - Phone:910-641-0600
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:1911 S 17TH ST
Practice Address - Street 2:WILMINGTON
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6662
Practice Address - Country:US
Practice Address - Phone:910-791-9625
Practice Address - Fax:252-638-3742
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290101YA0400X
NCC0034061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106950Medicaid