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NPI Code Detail

MEDICARE: MARECIUS D SAMUEL LPC, LCAS

MEDICARE: MARECIUS D SAMUEL LPC, LCAS
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
1101YM0800XMental Health Counselor11862NC
2101YA0400XAddiction (Substance Use Disorder) Counselor22144NC

General Provider Information

NPI Number : 1194193359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARECIUS D SAMUEL LPC, LCAS
Provider Business Mailing Address
First Line : 5540 CENTERVIEW DR STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27606-3386
Country : US
Telephone Number : 919-559-5568
Fax Number : 919-371-5599
Provider Business Practice Location Address
First Line : 5540 CENTERVIEW DR STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27606-3386
Country : US
Telephone Number : 919-559-5568
Fax Number : 919-371-5599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2015
Last Update Date : 12/18/2019

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