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General NPI Number Information
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NPI Number | 1194193359
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Entity Type | Individual
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Provider Name | MARECIUS D SAMUEL LPC, LCAS
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Gender | Male
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 5540 CENTERVIEW DR STE 200
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City | RALEIGH
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State | NC
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Zip | 27606-3386
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Country | US
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Telephone | 919-559-5568
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Fax | 919-371-5599
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Provider Business Mailing Address
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Address Line | 5540 CENTERVIEW DR STE 200
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City | RALEIGH
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State | NC
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Zip | 27606-3386
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Country | US
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Telephone | 919-559-5568
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Fax | 919-371-5599
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11862
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 22144
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License Number State | NC
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