Healthcare Provider Details

I. General information

NPI: 1437135639
Provider Name (Legal Business Name): MARILYN R GEBEL-SITTS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYN R GEBEL LCSW

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 MARKET ST
FORT MILL SC
29708-6496
US

IV. Provider business mailing address

1091 MARKET ST
FORT MILL SC
29708-6496
US

V. Phone/Fax

Practice location:
  • Phone: 703-728-4095
  • Fax: 703-642-6082
Mailing address:
  • Phone: 703-728-4095
  • Fax: 703-642-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC300051
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00816
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000774
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: