Provider Demographics
NPI:1164099875
Name:MARLIN, MARISSA AMBER (LPC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:AMBER
Last Name:MARLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:AMBER
Other - Last Name:DEYOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4535 GRAHAM DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8205
Mailing Address - Country:US
Mailing Address - Phone:870-378-2828
Mailing Address - Fax:
Practice Address - Street 1:420 W. BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-408-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2311009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health