Provider Demographics
NPI:1295036200
Name:ACKERMAN, MARILYN D (LISW,AP,BACS)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:D
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LISW,AP,BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 ISLAND VIEW CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8038
Mailing Address - Country:US
Mailing Address - Phone:843-606-2008
Mailing Address - Fax:
Practice Address - Street 1:409 COLEMAN BLVD
Practice Address - Street 2:STE 2 B
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4391
Practice Address - Country:US
Practice Address - Phone:843-606-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical