Provider Demographics
NPI:1033707310
Name:MARCELIN, ANN LORRY NATHALIE (LGPC)
Entity Type:Individual
Prefix:
First Name:ANN LORRY
Middle Name:NATHALIE
Last Name:MARCELIN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:ANN LORRY
Other - Middle Name:NATHALIE
Other - Last Name:LAMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12965 PINNACLE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-9104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 E DIAMOND AVE STE H
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5328
Practice Address - Country:US
Practice Address - Phone:240-683-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health