Provider Demographics
NPI:1205331857
Name:GLORIA, MARISSA SUE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:SUE
Last Name:GLORIA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:SUE
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:413 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9019
Mailing Address - Country:US
Mailing Address - Phone:989-854-6783
Mailing Address - Fax:
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:989-775-7701
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011021951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical