Provider Demographics
NPI:1558680926
Name:NETHERLAND, MARCIA J (MA, NCC, LPC, TF-CBT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:J
Last Name:NETHERLAND
Suffix:
Gender:F
Credentials:MA, NCC, LPC, TF-CBT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:J
Other - Last Name:CRIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LPC, TF-CBT
Mailing Address - Street 1:14734 AMBERJACK TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5800
Mailing Address - Country:US
Mailing Address - Phone:717-658-0581
Mailing Address - Fax:
Practice Address - Street 1:14734 AMBERJACK TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5800
Practice Address - Country:US
Practice Address - Phone:717-658-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006365101YP2500X
103K00000X
MO2019024180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102992907Medicaid