Provider Demographics
NPI:1679075576
Name:DEBOSE, MARCELLA LOUISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:LOUISE
Last Name:DEBOSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:LOUISE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15957 ALAMEDA DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1384
Mailing Address - Country:US
Mailing Address - Phone:412-719-4061
Mailing Address - Fax:
Practice Address - Street 1:15957 ALAMEDA DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1384
Practice Address - Country:US
Practice Address - Phone:412-719-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional