Provider Demographics
NPI:1700208766
Name:STELLA, MARK R (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:STELLA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TILIA CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3337
Mailing Address - Country:US
Mailing Address - Phone:609-819-5365
Mailing Address - Fax:
Practice Address - Street 1:11 TILIA CT
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3337
Practice Address - Country:US
Practice Address - Phone:609-819-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00621900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor