Provider Demographics
NPI:1679218846
Name:GRYNECHKO, MARCELINA BOZENA (LMFTA)
Entity Type:Individual
Prefix:
First Name:MARCELINA
Middle Name:BOZENA
Last Name:GRYNECHKO
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 POWER PLANT CIR APT 510
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4189
Mailing Address - Country:US
Mailing Address - Phone:785-477-8075
Mailing Address - Fax:
Practice Address - Street 1:713 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5808
Practice Address - Country:US
Practice Address - Phone:336-722-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12417A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist