Provider Demographics
NPI:1326635962
Name:MARCELL, CHRISTOPHER FRANK (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:FRANK
Last Name:MARCELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13068 TURTLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5540
Mailing Address - Country:US
Mailing Address - Phone:228-233-9294
Mailing Address - Fax:
Practice Address - Street 1:4905 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-1823
Practice Address - Country:US
Practice Address - Phone:228-769-1280
Practice Address - Fax:228-696-9119
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid