Provider Demographics
NPI:1376984815
Name:ORE-BOOTH, MARILYN YVONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:YVONNE
Last Name:ORE-BOOTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3840
Mailing Address - Country:US
Mailing Address - Phone:252-946-1055
Mailing Address - Fax:
Practice Address - Street 1:133 AVON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3840
Practice Address - Country:US
Practice Address - Phone:252-946-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical