Provider Demographics
NPI:1699472019
Name:MARCHELLO, GINA LOUISE (SUDPT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LOUISE
Last Name:MARCHELLO
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 N AUDUBON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7220
Mailing Address - Country:US
Mailing Address - Phone:424-750-6058
Mailing Address - Fax:
Practice Address - Street 1:628 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1377
Practice Address - Country:US
Practice Address - Phone:509-624-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)