Provider Demographics
NPI:1083036354
Name:ROBERSON, MARCELL JR (LPC,NCC,BHP)
Entity Type:Individual
Prefix:
First Name:MARCELL
Middle Name:
Last Name:ROBERSON
Suffix:JR
Gender:M
Credentials:LPC,NCC,BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 E. WILCOX DRIVE
Mailing Address - Street 2:ARIZONA COUNSELING & TREATMENT SERVICES
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-686-9252
Mailing Address - Fax:
Practice Address - Street 1:2039 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2781
Practice Address - Country:US
Practice Address - Phone:520-686-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional