Provider Demographics
NPI:1114240231
Name:FRAZIER, MARION EVERETTE (CSAC)
Entity Type:Individual
Prefix:MR
First Name:MARION
Middle Name:EVERETTE
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 BENJAMIN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1441
Mailing Address - Country:US
Mailing Address - Phone:252-443-1953
Mailing Address - Fax:252-442-0106
Practice Address - Street 1:203 S GRACE ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5604
Practice Address - Country:US
Practice Address - Phone:252-442-0100
Practice Address - Fax:252-442-0106
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-064-101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)