Provider Demographics
NPI:1487686283
Name:HART, MARISHA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARISHA
Middle Name:J
Last Name:HART
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 1:1205 CHESTNUT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-6496
Mailing Address - Country:US
Mailing Address - Phone:828-467-3698
Mailing Address - Fax:978-299-8407
Practice Address - Street 1:13 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-2938
Practice Address - Country:US
Practice Address - Phone:828-467-3698
Practice Address - Fax:978-299-8407
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106156Medicaid
NC2877389BMedicare ID - Type Unspecified