Provider Demographics
NPI:1629819701
Name:TRESIERRA VARGAS, MARCELA (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:TRESIERRA VARGAS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 MILTON RD STE 234
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3782
Mailing Address - Country:US
Mailing Address - Phone:980-285-3689
Mailing Address - Fax:
Practice Address - Street 1:3126 MILTON RD STE 235
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3782
Practice Address - Country:US
Practice Address - Phone:980-285-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health