Provider Demographics
NPI:1194368431
Name:BRIMMAGE, MARILYN K (MA LPCA LCASA)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:K
Last Name:BRIMMAGE
Suffix:
Gender:F
Credentials:MA LPCA LCASA
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 654
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-0654
Mailing Address - Country:US
Mailing Address - Phone:919-223-7970
Mailing Address - Fax:
Practice Address - Street 1:110 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-2124
Practice Address - Country:US
Practice Address - Phone:919-635-3344
Practice Address - Fax:919-635-3388
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15194101YP2500X
NCLCAS-A-25746101YA0400X
NCCSAPC-20397405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional