Provider Demographics
NPI:1619252079
Name:KRENZEL, MARY (LCMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KRENZEL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:KRENZEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMCHC
Mailing Address - Street 1:1211 CROSS WATER CIR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1519
Mailing Address - Country:US
Mailing Address - Phone:248-835-5175
Mailing Address - Fax:
Practice Address - Street 1:6209 OLEANDER DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3582
Practice Address - Country:US
Practice Address - Phone:910-777-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional