Provider Demographics
NPI:1295181204
Name:NESMITH, MARLISA
Entity Type:Individual
Prefix:
First Name:MARLISA
Middle Name:
Last Name:NESMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3015
Mailing Address - Country:US
Mailing Address - Phone:803-225-0941
Mailing Address - Fax:803-478-4161
Practice Address - Street 1:209 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3015
Practice Address - Country:US
Practice Address - Phone:803-225-0941
Practice Address - Fax:803-478-4161
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker