Provider Demographics
NPI:1891841904
Name:AIN, MARILYN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:E
Last Name:AIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 YAUPON WAY
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8365
Mailing Address - Country:US
Mailing Address - Phone:910-520-8337
Mailing Address - Fax:
Practice Address - Street 1:16 YAUPON WAY
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-8365
Practice Address - Country:US
Practice Address - Phone:910-520-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000787Medicaid
NC2811554Medicare ID - Type Unspecified