Provider Demographics
NPI:1811046048
Name:KENT-WHITE, MARISSA (BS, MS)
Entity Type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:
Last Name:KENT-WHITE
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0728
Mailing Address - Country:US
Mailing Address - Phone:828-586-6600
Mailing Address - Fax:828-586-6601
Practice Address - Street 1:669 S HAYWOOD ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6703
Practice Address - Country:US
Practice Address - Phone:828-456-2997
Practice Address - Fax:828-456-2996
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist