Provider Demographics
NPI:1104340843
Name:MARCELLUS, CHIZOBA LOVETH (LMHC)
Entity type:Individual
Prefix:
First Name:CHIZOBA
Middle Name:LOVETH
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CHIZOBA
Other - Middle Name:LOVETH
Other - Last Name:ADIZUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:536 NE 206TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3589
Mailing Address - Country:US
Mailing Address - Phone:305-528-5849
Mailing Address - Fax:
Practice Address - Street 1:66 W FLAGLER ST STE 900
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1807
Practice Address - Country:US
Practice Address - Phone:305-761-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH23214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst