Provider Demographics
NPI:1902368632
Name:CELLI, GENEVIEVE ANDREE
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ANDREE
Last Name:CELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:43155-0243
Mailing Address - Country:US
Mailing Address - Phone:614-404-6008
Mailing Address - Fax:470-277-7790
Practice Address - Street 1:551 1/2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3809
Practice Address - Country:US
Practice Address - Phone:614-404-6008
Practice Address - Fax:740-277-7790
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X, 106S00000X, 246Z00000X
OHCDCA.175092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH004OtherCREED INTEGRATED BEAHAVIORAL HEALTH SERVICES