Provider Demographics
NPI:1134699549
Name:DEL HIERRO, MARLENA LEE (LPCA #A14482)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:LEE
Last Name:DEL HIERRO
Suffix:
Gender:F
Credentials:LPCA #A14482
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 MAR DON DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4624
Mailing Address - Country:US
Mailing Address - Phone:336-923-7426
Mailing Address - Fax:
Practice Address - Street 1:983 MAR DON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4624
Practice Address - Country:US
Practice Address - Phone:336-923-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health