Provider Demographics
NPI:1669931374
Name:MARCEL, LORI KAY (CADC LL)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:MARCEL
Suffix:
Gender:F
Credentials:CADC LL
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:KAY
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC II
Mailing Address - Street 1:521 DE LA VINA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-8037
Mailing Address - Country:US
Mailing Address - Phone:805-570-6269
Mailing Address - Fax:
Practice Address - Street 1:521 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-8037
Practice Address - Country:US
Practice Address - Phone:805-570-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X
CA127041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty