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General NPI Number Information
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NPI Number | 1114305760
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Entity Type | Individual
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Provider Name | MARCELLE LYNN ANCRUM LPC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 7145 GERMANTOWN AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19119
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Country | US
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Telephone | 215-247-1427
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Fax | 267-297-5169
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Provider Business Mailing Address
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Address Line | 1048 E. UPSAL ST.
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City | PHILADELPHIA
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State | PA
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Zip | 19150
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Country | US
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Telephone | 215-548-7747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC002483
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License Number State | PA
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