Provider Demographics
NPI:1922271196
Name:LUGO, MARIELLIE (CAC II)
Entity Type:Individual
Prefix:MS
First Name:MARIELLIE
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 DAWSON BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1259
Mailing Address - Country:US
Mailing Address - Phone:770-662-0249
Mailing Address - Fax:779-449-5023
Practice Address - Street 1:6020 DAWSON BLVD STE I
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1259
Practice Address - Country:US
Practice Address - Phone:770-662-0249
Practice Address - Fax:779-449-5023
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health