Provider Demographics
NPI:1407191893
Name:TIME, MARJORIE MARIE
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:MARIE
Last Name:TIME
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 1:2814 S US HWY.#1 STE. D-4
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-489-4726
Mailing Address - Fax:772-489-0423
Practice Address - Street 1:2814 S. US HWY. #1, STE.D-4
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:772-489-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health