Provider Demographics
NPI:1104241124
Name:CARLTON, MARELLA
Entity type:Individual
Prefix:
First Name:MARELLA
Middle Name:
Last Name:CARLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SCHAUB DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1862
Mailing Address - Country:US
Mailing Address - Phone:919-834-2000
Mailing Address - Fax:919-834-2001
Practice Address - Street 1:1011 SCHAUB DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1862
Practice Address - Country:US
Practice Address - Phone:919-834-2000
Practice Address - Fax:919-834-2001
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional