Provider Demographics
NPI:1427219476
Name:POPE, MARIE LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LEE
Last Name:POPE
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 1:300 CLEARFIELD DR
Mailing Address - Street 2:APARTMENT 608
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4115
Mailing Address - Country:US
Mailing Address - Phone:252-578-2236
Mailing Address - Fax:252-537-6793
Practice Address - Street 1:1609 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4103
Practice Address - Country:US
Practice Address - Phone:252-678-0850
Practice Address - Fax:252-537-6793
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional