Provider Demographics
NPI:1508292699
Name:MORGAN, MARIE ANTOINETTE (LCAS)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11000 MORGAN CREEK DR
Mailing Address - Street 2:204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4113
Mailing Address - Country:US
Mailing Address - Phone:704-301-1495
Mailing Address - Fax:
Practice Address - Street 1:11000 MORGAN CREEK DR
Practice Address - Street 2:204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4113
Practice Address - Country:US
Practice Address - Phone:704-301-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)