Provider Demographics
NPI:1841389616
Name:GRENELL, MARCIA M (PHD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:M
Last Name:GRENELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 ARLINGTON BLVD # G
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2708
Mailing Address - Country:US
Mailing Address - Phone:703-536-7554
Mailing Address - Fax:703-536-7554
Practice Address - Street 1:6107 ARLINGTON BLVD # G
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2708
Practice Address - Country:US
Practice Address - Phone:703-536-7554
Practice Address - Fax:703-536-7554
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical