Self Love Outpatient Services

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SELF LOVE OUTPATIENT SERVICES

Practice address

306 Turner Rd Ste a-B
North Chesterfield, VA 23225-6432

Phone

(631) 805-3257

NPI assigned

Oct 26, 2023

Last updated

Oct 26, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Greogory D Marcelle Jr., M.ED., LPC, CAADC

Title

Ceo

Phone

(631) 805-3257

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1033981618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5927 BELSTON CT",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232343214",
            "telephone_number": "631-805-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 TURNER RD STE A-B",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232256432",
            "telephone_number": "631-805-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF LOVE OUTPATIENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "MARCELLE",
        "authorized_official_first_name": "GREOGORY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "631-805-3257",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.ED., LPC, CAADC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.