Healthcare Provider Details

I. General information

NPI: 1679218846
Provider Name (Legal Business Name): MARCELINA BOZENA GRYNECHKO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IOWA LN STE 204
CARY NC
27511-2400
US

IV. Provider business mailing address

539 POWER PLANT CIR APT 510
WINSTON SALEM NC
27101-4189
US

V. Phone/Fax

Practice location:
  • Phone: 919-587-8018
  • Fax:
Mailing address:
  • Phone: 785-477-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00197
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: