Provider Demographics
NPI:1619375631
Name:PETRINI, MARCELLA (LPCA)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:
Last Name:PETRINI
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CAROLINA ST
Mailing Address - Street 2:#114
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1032
Mailing Address - Country:US
Mailing Address - Phone:336-542-2060
Mailing Address - Fax:
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:#114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-542-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional