Provider Demographics
NPI:1184440315
Name:OTERO, MARLENE (LMHCA)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:OTERO
Suffix:
Gender:
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 YELLOW HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WADMALAW ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29487-7205
Mailing Address - Country:US
Mailing Address - Phone:404-388-1955
Mailing Address - Fax:
Practice Address - Street 1:1610 YELLOW HOUSE RD
Practice Address - Street 2:
Practice Address - City:WADMALAW ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29487-7205
Practice Address - Country:US
Practice Address - Phone:404-388-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61627077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health