Provider Demographics
NPI:1881405702
Name:WILSON, MARISSA JEANNE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JEANNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 NEELLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-9227
Mailing Address - Country:US
Mailing Address - Phone:336-479-3301
Mailing Address - Fax:
Practice Address - Street 1:5 OAK BRANCH DR STE H
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2157
Practice Address - Country:US
Practice Address - Phone:336-288-9190
Practice Address - Fax:336-450-4318
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0216841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical