Provider Demographics
NPI:1144482811
Name:JOSEPH, CECELIA A (LCAS)
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 EXECUTIVE CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8869
Mailing Address - Country:US
Mailing Address - Phone:336-882-2125
Mailing Address - Fax:336-882-8153
Practice Address - Street 1:1800 MARTIN LUTHER KING PKWY STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3500
Practice Address - Country:US
Practice Address - Phone:704-227-0605
Practice Address - Fax:704-227-0690
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112038Medicaid