Provider Demographics
NPI:1801939392
Name:FOUGERE, MARIANNE KIKTA (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:KIKTA
Last Name:FOUGERE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GRAPEVINE TRL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5296
Mailing Address - Country:US
Mailing Address - Phone:951-532-5532
Mailing Address - Fax:
Practice Address - Street 1:5850 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6289
Practice Address - Country:US
Practice Address - Phone:919-294-8981
Practice Address - Fax:919-999-2497
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0082431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical