Provider Demographics
NPI:1952120149
Name:GELLINEAU, AYANNA MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:MICHELLE
Last Name:GELLINEAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 WYNNEWOOD RD # U1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3452
Mailing Address - Country:US
Mailing Address - Phone:609-798-1597
Mailing Address - Fax:
Practice Address - Street 1:881 WYNNEWOOD RD # U1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3452
Practice Address - Country:US
Practice Address - Phone:609-798-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional