NPIMap

Individual provider Active NPI

Marecius D Samuel, LPC, LCAS

  • Addiction (Substance Use Disorder) Counselor
  • Raleigh, NC
National Provider Identifier
1194193359
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
22144 Issued in NC
Practice address
5540 Centerview Dr Ste 200
Raleigh, NC 27606-3386
Phone
(919) 559-5568
Fax
(919) 371-5599
NPI assigned
Sep 4, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 11862 NC
Addiction (Substance Use Disorder) Counselor 101YA0400X 22144 NC Primary

Addresses

Primary practice location

5540 Centerview Dr Ste 200
Raleigh, NC 27606-3386

Mailing address

5540 Centerview Dr Ste 200
Raleigh, NC 27606-3386
Phone (919) 559-5568

Other practice location 1

309 W Millbrook Rd
Raleigh, NC 27609-4385
Phone (919) 830-5749

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

State licenses

LicenseStateTypeSpecialty
22144NCMDAddiction (Substance Use Disorder) Counselor
11862NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Carter Clinic, P.a. PastSince Aug 25, 2019 Accepting new patients
Carter Clinic, P.a. PastSince Mar 4, 2021 Accepting new patients
Carter Clinic, P a Mental Health Past Accepting new patients
Carter Clinic, PA Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1441324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1194193359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5540 CENTERVIEW DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063386",
            "telephone_number": "919-559-5568",
            "fax_number": "919-371-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5540 CENTERVIEW DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063386",
            "telephone_number": "919-559-5568",
            "fax_number": "919-371-5599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 W Millbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276094385",
            "country_code": "US",
            "telephone_number": "919-830-5749",
            "fax_number": "919-822-1277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "MARECIUS",
        "middle_name": "D",
        "credential": "LPC, LCAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-04",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "11862",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "22144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.