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General NPI Number Information
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NPI Number | 1285989525
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Entity Type | Individual
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Provider Name | MARIAN G UPTON LPC, CRC, CCDC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT MEADE
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State | MD
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Zip | 20755-7081
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Country | US
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Telephone | 301-677-7981
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT MEADE
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State | MD
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Zip | 20755-7081
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Country | US
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Telephone | 301-677-7981
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CRC # 00112609
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License Number State |
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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 | 4244
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-4988
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License Number State | ID
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