Provider Demographics
NPI:1689058703
Name:FUNK, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 RUBY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4141
Mailing Address - Country:US
Mailing Address - Phone:919-883-5372
Mailing Address - Fax:
Practice Address - Street 1:104 S ESTES DR
Practice Address - Street 2:SUITE 301-U
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-883-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0104391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical