=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831454719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNETTE MARIE MARCIEL M.ED, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2012
-----------------------------------------------------
Last Update Date | 03/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 218 N 4TH AVE SUITE 204
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-1472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-303-3419
-----------------------------------------------------
Fax | 734-344-7431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 TOLAN ST
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48160-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-303-3419
-----------------------------------------------------
Fax | 734-344-7431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | PRC14299
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401015812
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701005447
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------