Provider Demographics
NPI:1770558926
Name:AZAR, MARILYN GAIL (LPC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:GAIL
Last Name:AZAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIDDEN VW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NC
Mailing Address - Zip Code:28701-9678
Mailing Address - Country:US
Mailing Address - Phone:828-645-3351
Mailing Address - Fax:828-225-2531
Practice Address - Street 1:70 WOODFIN PL
Practice Address - Street 2:SUITE #021
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2463
Practice Address - Country:US
Practice Address - Phone:828-768-9192
Practice Address - Fax:828-225-2531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1297UOtherBCBSNC
NC6102021Medicaid