Provider Demographics
NPI:1497273049
Name:SCHORR, MARISA GABRIELLE (LPA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:GABRIELLE
Last Name:SCHORR
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 RAINBOW MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:906-869-4775
Mailing Address - Fax:
Practice Address - Street 1:413 MCCONNELL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-246-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist