MEDICARE: SAMANTHEO MARCELLUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4657	NC
2	101YP2500X	Professional Counselor	4657	NC

General Provider Information

NPI Number	:	1184851743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHEO MARCELLUS

Provider Business Mailing Address
First Line	:	1804 MARTIN LUTHER KING PKWY STE 210
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 MARTIN LUTHER KING PKWY STE 210
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3587
Country	:	US
Telephone Number	:	919-489-2254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

Similar Medicare Providers

1891659413 — MADELINE MARIE RUSSELL
Practice Location Address:

1804 MARTIN LUTHER KING PKWY
DURHAM, NC
27707-3587

Practice Phone: 919-246-5664
Practice Fax:

1710078761 — LIVING WELL CENTRE, INC.
Practice Location Address:

1804 MARTIN LUTHER KING PKWY , SUITE 210
DURHAM, NC
27707-3587

Practice Phone: 919-489-2254
Practice Fax: 919-403-1551

1467525873 — SQUARE ONE WELLNESS CENTER, INC.
Practice Location Address:

1804 MARTIN LUTHER KING PKWY STE 111
DURHAM, NC
27707-3587

Practice Phone: 704-956-3062
Practice Fax:

1629132097 — LIVING WELL CENTRE
Practice Location Address:

1804 MLK JR. PARKWAY , SUITE 210
DURHAM, NC
27707-3587

Practice Phone: 919-489-2254
Practice Fax: 919-403-1551

1053475780 — LIVING WELL CENTRE
Practice Location Address:

1804 MLK JR. PARKWAY , SUITE 210
DURHAM, NC
27707-3587

Practice Phone: 919-489-2254
Practice Fax: 919-403-1551

1104040294 — LIVING WELL CENTRE
Practice Location Address:

1804 MLK JR PKWY , SUITE 210
DURHAM, NC
27707-3587

Practice Phone: 919-489-2254
Practice Fax:

Directions to “ SAMANTHEO MARCELLUS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.