Provider Demographics
NPI:1396567640
Name:DEMONICO, PAULINE (LCAS, CCS)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:DEMONICO
Suffix:
Gender:F
Credentials:LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 ROUSSEAU CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2103
Mailing Address - Country:US
Mailing Address - Phone:732-337-5819
Mailing Address - Fax:
Practice Address - Street 1:2923 ROUSSEAU CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2103
Practice Address - Country:US
Practice Address - Phone:732-337-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)