Provider Demographics
NPI:1841594710
Name:ROTHMAN, MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OLD CANTON RD STE 465
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4225
Mailing Address - Country:US
Mailing Address - Phone:601-977-9081
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD CANTON RD STE 465
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4225
Practice Address - Country:US
Practice Address - Phone:601-977-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health