Provider Demographics
NPI:1982786927
Name:HUESTON, MARLA LYNN (MA LPC)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:LYNN
Last Name:HUESTON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 S. CROATAN HWY
Mailing Address - Street 2:P.O. BOX 1685
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959
Mailing Address - Country:US
Mailing Address - Phone:252-441-9400
Mailing Address - Fax:252-441-3366
Practice Address - Street 1:407 NORTH MAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954
Practice Address - Country:US
Practice Address - Phone:252-441-9400
Practice Address - Fax:252-441-3366
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102514Medicaid