Provider Demographics
NPI:1831358761
Name:JOSIAH, MARISSA (LC2821)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:JOSIAH
Suffix:
Gender:F
Credentials:LC2821
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12171 CLARKSVILLE PIKE # 911
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-9904
Mailing Address - Country:US
Mailing Address - Phone:443-927-7797
Mailing Address - Fax:
Practice Address - Street 1:12171 CLARKSVILLE PIKE # 911
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-9904
Practice Address - Country:US
Practice Address - Phone:443-927-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional