Provider Demographics
NPI:1447919337
Name:MARIE, DENISE (LCPC, ATR-BC,NBC-HWC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MARIE
Suffix:
Gender:F
Credentials:LCPC, ATR-BC,NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 CENTRAL AVE UNIT 517
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3661
Mailing Address - Country:US
Mailing Address - Phone:773-216-2193
Mailing Address - Fax:
Practice Address - Street 1:855 CENTRAL AVE UNIT 517
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3661
Practice Address - Country:US
Practice Address - Phone:773-216-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
04-067221700000X
IL180.005239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist