Active NPI
Samantheo Marcellus
- Professional Counselor
- Durham, NC
National Provider Identifier
1184851743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4657
- Practice address
- 1804 Martin Luther King Pkwy Ste 210
Durham, NC 27707-3587 - Phone
- (919) 489-2254
- NPI assigned
- Jun 22, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 4657 | NC | |
| Professional Counselor | 101YP2500X | 4657 | NC | Primary |
Addresses
Primary practice location
1804 Martin Luther King Pkwy Ste 210
Durham, NC 27707-3587
Mailing address
1804 Martin Luther King Pkwy Ste 210
Durham, NC 27707-3587
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245628800000",
"number": "1184851743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 MARTIN LUTHER KING PKWY STE 210",
"city": "DURHAM",
"state": "NC",
"postal_code": "277073587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1804 MARTIN LUTHER KING PKWY STE 210",
"city": "DURHAM",
"state": "NC",
"postal_code": "277073587",
"telephone_number": "919-489-2254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCELLUS",
"first_name": "SAMANTHEO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-22",
"last_updated": "2009-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "4657",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "4657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.