Provider Demographics
NPI:1578593364
Name:FUSELIER, MARELLA MAE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARELLA
Middle Name:MAE
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-0363
Mailing Address - Country:US
Mailing Address - Phone:337-896-7202
Mailing Address - Fax:
Practice Address - Street 1:611 W ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6408
Practice Address - Country:US
Practice Address - Phone:337-373-2135
Practice Address - Fax:337-373-0125
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)