Provider Demographics
NPI:1003456575
Name:LEADING, ELEVATING, VALUING, EVERYONE, LAUNCHING, SUCCESS
Entity type:Organization
Organization Name:LEADING, ELEVATING, VALUING, EVERYONE, LAUNCHING, SUCCESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:MARCELLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MED, LPC, CAADC
Authorized Official - Phone:631-805-3257
Mailing Address - Street 1:5927 BELSTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3214
Mailing Address - Country:US
Mailing Address - Phone:631-805-3257
Mailing Address - Fax:
Practice Address - Street 1:5927 BELSTON CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3214
Practice Address - Country:US
Practice Address - Phone:631-805-3257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase Management