Provider Demographics
NPI:1831796044
Name:GIAMANCO, ANNALISE
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:GIAMANCO
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 1:3496 WALNUT VW
Mailing Address - Street 2:
Mailing Address - City:BYRNES MILL
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2902
Mailing Address - Country:US
Mailing Address - Phone:314-604-4064
Mailing Address - Fax:
Practice Address - Street 1:300 BILLINGSLEY RD STE 107
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1084
Practice Address - Country:US
Practice Address - Phone:704-665-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1674103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst