Provider Demographics
NPI:1255994703
Name:GELLER, EMALIE GENE
Entity type:Individual
Prefix:
First Name:EMALIE
Middle Name:GENE
Last Name:GELLER
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 1:68 SANPATRICE CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9543
Mailing Address - Country:US
Mailing Address - Phone:262-388-3648
Mailing Address - Fax:
Practice Address - Street 1:5121 KINGDOM WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6062
Practice Address - Country:US
Practice Address - Phone:919-390-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician