| Organization Name: | SOUTHEAST CHILD & FAMILY GUIDANCE, PLLC |
| NPI Number: | 1356629273 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA IANNELLI (LICENSED CLINICAL SOCIAL WORKER) |
| Mailing Address: | 400 N Broome St Suite 301 Waxhaw |
| State: | NC US |
| Postal Code: | 281737032 |
| Phone Number: | 7042560305 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2011 |
| NPI Last Update Date: | 07/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |