Provider Demographics
NPI:1851720205
Name:CANNELLA, GEORGE (MA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:CANNELLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8883
Mailing Address - Country:US
Mailing Address - Phone:704-537-1289
Mailing Address - Fax:
Practice Address - Street 1:5855 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8883
Practice Address - Country:US
Practice Address - Phone:704-537-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health