Provider Demographics
NPI:1700916293
Name:MORGAN, MARILYN (LPC,LPCC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LPC,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 CALLE DE MOLINA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9261
Mailing Address - Country:US
Mailing Address - Phone:505-474-3295
Mailing Address - Fax:
Practice Address - Street 1:210 SAND PEBBLE DR SE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9537
Practice Address - Country:US
Practice Address - Phone:505-474-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14228101YP2500X
NM005907101YA0400X, 101YM0800X, 101YP2500X
UT326516-6004101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health