Provider Demographics
NPI:1962019349
Name:MCCALL, MARLINA CHARISSE (LPCC)
Entity type:Individual
Prefix:
First Name:MARLINA
Middle Name:CHARISSE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 IRVING BLVD NW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5529
Mailing Address - Country:US
Mailing Address - Phone:505-550-9366
Mailing Address - Fax:
Practice Address - Street 1:4477 IRVING BLVD NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5529
Practice Address - Country:US
Practice Address - Phone:505-550-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM386595101YS0200X
NMCTB-2024-0296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool