Provider Demographics
NPI:1235936667
Name:MCDONALD, MARCELLUS HASONE (LMBT)
Entity type:Individual
Prefix:
First Name:MARCELLUS
Middle Name:HASONE
Last Name:MCDONALD
Suffix:
Gender:
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 BOB WHITE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3203
Mailing Address - Country:US
Mailing Address - Phone:910-882-1923
Mailing Address - Fax:
Practice Address - Street 1:506 BOB WHITE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3203
Practice Address - Country:US
Practice Address - Phone:910-882-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist