Provider Demographics
NPI:1821757212
Name:HOWARD, MARISSA L
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:L
Last Name:HOWARD
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 1:190 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3654
Mailing Address - Country:US
Mailing Address - Phone:931-374-5172
Mailing Address - Fax:
Practice Address - Street 1:190 CHERRY HILL DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3654
Practice Address - Country:US
Practice Address - Phone:931-374-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician