Provider Demographics
NPI:1942864962
Name:SERRA, GAETANO (LCMHC, LMHC, NCC)
Entity Type:Individual
Prefix:MR
First Name:GAETANO
Middle Name:
Last Name:SERRA
Suffix:
Gender:M
Credentials:LCMHC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 HINMAN LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-4166
Mailing Address - Country:US
Mailing Address - Phone:919-446-3099
Mailing Address - Fax:
Practice Address - Street 1:2500 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8549
Practice Address - Country:US
Practice Address - Phone:919-446-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009305101YM0800X
NC14814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health