Provider Demographics
NPI:1891824843
Name:QUESADA, MARCELLA ELOISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:ELOISE
Last Name:QUESADA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:MARCELLA
Other - Middle Name:ELOISE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4940 BROADWAY STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5732
Mailing Address - Country:US
Mailing Address - Phone:904-894-6623
Mailing Address - Fax:210-468-6203
Practice Address - Street 1:4940 BROADWAY STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5732
Practice Address - Country:US
Practice Address - Phone:904-894-6623
Practice Address - Fax:210-468-6203
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health