Provider Demographics
NPI:1932675972
Name:GEORGIANA, TONI (LCSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:GEORGIANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 JANSTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1082
Mailing Address - Country:US
Mailing Address - Phone:843-957-5455
Mailing Address - Fax:
Practice Address - Street 1:5613 DURALEIGH RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2694
Practice Address - Country:US
Practice Address - Phone:843-957-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0118101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical