Provider Demographics
NPI:1477044659
Name:MARCELLUS, ALETHEA SAMONE (MS, PSYCH, ACAS,ITFS)
Entity Type:Individual
Prefix:MRS
First Name:ALETHEA
Middle Name:SAMONE
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:MS, PSYCH, ACAS,ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 MINT JULEP DR
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7817
Mailing Address - Country:US
Mailing Address - Phone:919-609-8160
Mailing Address - Fax:
Practice Address - Street 1:2556 MINT JULEP DR
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-609-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No252Y00000XAgenciesEarly Intervention Provider Agency