Provider Demographics
NPI:1124298997
Name:MARLISA VAN HOUT PC
Entity type:Organization
Organization Name:MARLISA VAN HOUT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLISA
Authorized Official - Middle Name:NANCE
Authorized Official - Last Name:VAN HOUT
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:910-343-8424
Mailing Address - Street 1:1907 S 17TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6679
Mailing Address - Country:US
Mailing Address - Phone:910-343-8424
Mailing Address - Fax:910-343-6989
Practice Address - Street 1:1907 S 17TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6679
Practice Address - Country:US
Practice Address - Phone:910-343-8424
Practice Address - Fax:910-343-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty