Basic Information
| Provider Information | |||||||||
| NPI: | 1730218389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASQUARELLI | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4203 GRAND CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261051827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042957187 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2121 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044851721 | ||||||||
| FaxNumber: | 3404856710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 946 | WV | X | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | E1042 | OH | X | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 946 | WV | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | E1042 | OH | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 946 | WV | X | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | E1042 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | E1042 | 01 | OH | OH LPCC | OTHER | 946 | 01 | WV | WV LPC | OTHER |