Healthcare Provider Details

I. General information

NPI: 1750722005
Provider Name (Legal Business Name): MARLA P. GENTILE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 MATTERHORN DRIVE
PINE MTN CLUB CA
93222
US

IV. Provider business mailing address

PO BOX 5191
PINE MOUNTAIN CLUB CA
93222-5191
US

V. Phone/Fax

Practice location:
  • Phone: 828-719-1048
  • Fax:
Mailing address:
  • Phone: 828-719-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6854
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: