Provider Demographics
NPI:1659961100
Name:MARSH, CELESTE PEARL DELANA
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:PEARL DELANA
Last Name:MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 GILBERT STATION RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2006
Mailing Address - Country:US
Mailing Address - Phone:804-625-5903
Mailing Address - Fax:
Practice Address - Street 1:4916 PLANK RD UPPR SUITE6
Practice Address - Street 2:
Practice Address - City:NORTH GARDEN
Practice Address - State:VA
Practice Address - Zip Code:22959-1613
Practice Address - Country:US
Practice Address - Phone:434-989-9360
Practice Address - Fax:804-716-7186
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician