Provider Demographics
NPI:1982642575
Name:PAGETT, MARILYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:PAGETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:BABULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:247 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2247
Mailing Address - Country:US
Mailing Address - Phone:828-686-5468
Mailing Address - Fax:828-225-4822
Practice Address - Street 1:1340 PATTON AVE STE H
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2623
Practice Address - Country:US
Practice Address - Phone:828-225-4980
Practice Address - Fax:828-225-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136F1OtherBCBSNC GRP # 015HF
NC6002987Medicaid
NC2878324Medicare ID - Type UnspecifiedLCSW GRP #2335660A