Individual
MR. NICOLAE CODRUT MARIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
4672 MAVERICK LN STE 1A, LAKESIDE, AZ 85929-5434
(520) 481-7461
Mailing address
650 N PENROD RD, SUITE A # 724, SHOW LOW, AZ 85901-5284
(520) 481-7461
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
LAC-23279
AZ
101YP2500X
Professional Counselor
Primary
LAC-23279
AZ
101YP2500X
Professional Counselor
LAC-23279
—
Other
Enumeration date
11/20/2025
Last updated
11/20/2025
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