Healthcare Provider Details

I. General information

NPI: 1437391182
Provider Name (Legal Business Name): MARILYN HULL CIRULIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 EAST 5TH STREET SUITE 110
CHARLOTTE NC
28204-2472
US

IV. Provider business mailing address

917 1ST ST
SHELBY NC
28150-3958
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-5354
  • Fax: 704-375-3069
Mailing address:
  • Phone: 704-476-4085
  • Fax: 704-476-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number57
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: