Provider Demographics
NPI:1497561815
Name:ANDERSON, MARINELA (LCDC)
Entity type:Individual
Prefix:MS
First Name:MARINELA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-7901
Mailing Address - Country:US
Mailing Address - Phone:281-946-4344
Mailing Address - Fax:
Practice Address - Street 1:4525 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-7901
Practice Address - Country:US
Practice Address - Phone:281-946-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)