Provider Demographics
NPI:1942414354
Name:GELLER, JANICE (MA,LPC,)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:MA,LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 TROON LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1829
Mailing Address - Country:US
Mailing Address - Phone:919-384-0323
Mailing Address - Fax:919-384-0323
Practice Address - Street 1:5127 TROON LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1829
Practice Address - Country:US
Practice Address - Phone:919-384-0323
Practice Address - Fax:919-384-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133C5OtherBCBS PROVIDER I.D. NUMBE