Provider Demographics
NPI:1831734730
Name:MARCELLE, GREGORY B JR (MED, LPC, CAADC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:B
Last Name:MARCELLE
Suffix:JR
Gender:M
Credentials:MED, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2106101YA0400X
VA0701008785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)