Provider Demographics
NPI:1720451404
Name:SEALS, MARLA DANIELLE (LCPC, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:DANIELLE
Last Name:SEALS
Suffix:
Gender:F
Credentials:LCPC, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NORTHSIDE DR NW STE A7
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2695
Mailing Address - Country:US
Mailing Address - Phone:773-703-8016
Mailing Address - Fax:
Practice Address - Street 1:1700 NORTHSIDE DR NW STE A7
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2695
Practice Address - Country:US
Practice Address - Phone:773-703-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010065101YP2500X, 101Y00000X, 101YM0800X
WALH61111242101YM0800X, 101YP2500X, 101Y00000X
IL180007323101YP2500X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor