Marilynne Sue Walpole, CADC L CA
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Eureka, CA
NPI 1043965700 · NPPES record last updated Feb 21, 2022
Key facts
- NPI
- 1043965700
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CICA05000821 (CA)
- Practice address
- 2107 1St St
Eureka, CA 95501-0840 - Phone
- (707) 273-6395
- NPI assigned
- Feb 21, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CICA05000821 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Treatment Centers, LLC | Current |
Accepting new patients |
Locations
2107 1st St
Eureka, CA 95501
Phone (707) 273-6395
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CICA05000821 | CA | Yes |
Addresses
Primary practice location
2107 1St St
Eureka, CA 95501-0840
Mailing address
2107 1St St
Eureka, CA 95501-0840
Phone (707) 498-1865
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Medicaid | CA |
Other providers in Eureka, CA
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- Victor Wallenkampf
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- Emily Rose Walsh
- Patrick Walsh
- Deborah Waranowski
- Bambi Lynn Ward-Roller
- Cheri Ward
All providers in Eureka, CA · Addiction (Substance Use Disorder) Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.