Provider Demographics
NPI:1194193359
Name:SAMUEL, MARECIUS D (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:MARECIUS
Middle Name:D
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 CENTERVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3386
Mailing Address - Country:US
Mailing Address - Phone:919-559-5568
Mailing Address - Fax:919-371-5599
Practice Address - Street 1:5540 CENTERVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3386
Practice Address - Country:US
Practice Address - Phone:919-559-5568
Practice Address - Fax:919-371-5599
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11862101YM0800X
NC22144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health