Provider Demographics
NPI:1417919697
Name:HART, MARION KEITH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:KEITH
Last Name:HART
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ROGER DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-8875
Mailing Address - Country:US
Mailing Address - Phone:704-638-9000
Mailing Address - Fax:704-645-6011
Practice Address - Street 1:1601 BRENNER AVENUE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:704-645-6011
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical