Provider Demographics
NPI:1912523416
Name:KANICH, YAEL SARAI COSIO (MA, LMFTA)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:SARAI COSIO
Last Name:KANICH
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1584
Mailing Address - Country:US
Mailing Address - Phone:919-740-1683
Mailing Address - Fax:
Practice Address - Street 1:9205 BAILEYWICK RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1977
Practice Address - Country:US
Practice Address - Phone:919-845-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12223A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist