Provider Demographics
NPI:1093273120
Name:SAXON, MARICELLY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARICELLY
Middle Name:
Last Name:SAXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:SAXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALC
Mailing Address - Street 1:557 GLOVER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2070
Mailing Address - Country:US
Mailing Address - Phone:334-347-1862
Mailing Address - Fax:334-347-2919
Practice Address - Street 1:557 GLOVER AVE STE 3
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2070
Practice Address - Country:US
Practice Address - Phone:334-347-1862
Practice Address - Fax:334-347-2919
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional