Provider Demographics
NPI:1902372840
Name:RAMIREZ, MARIELLY
Entity Type:Individual
Prefix:
First Name:MARIELLY
Middle Name:
Last Name:RAMIREZ
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 1:2301 CROWNPOINT EXECUTIVE DR STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6725
Mailing Address - Country:US
Mailing Address - Phone:704-708-8314
Mailing Address - Fax:704-708-8315
Practice Address - Street 1:2301 CROWNPOINT EXECUTIVE DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6725
Practice Address - Country:US
Practice Address - Phone:704-708-8314
Practice Address - Fax:704-708-8315
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-18-68262106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician