Provider Demographics
NPI:1093268633
Name:MARSH, CARISSA (PHD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28555-0388
Mailing Address - Country:US
Mailing Address - Phone:910-378-2678
Mailing Address - Fax:910-900-0930
Practice Address - Street 1:200 DOCTORS DR STE M
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-378-2678
Practice Address - Fax:910-900-0930
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5249103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist