Provider Demographics
NPI:1265949630
Name:MARCELLIS, SAMANTHA LEE HOOVER (LCPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE HOOVER
Last Name:MARCELLIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8538
Mailing Address - Country:US
Mailing Address - Phone:847-971-0100
Mailing Address - Fax:
Practice Address - Street 1:13707 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3188
Practice Address - Country:US
Practice Address - Phone:815-759-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-06
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional