Provider Demographics
NPI:1124426309
Name:VAN NUENEN, MARIEKE
Entity type:Individual
Prefix:MS
First Name:MARIEKE
Middle Name:
Last Name:VAN NUENEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 N MORNINGSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3260
Mailing Address - Country:US
Mailing Address - Phone:404-680-1438
Mailing Address - Fax:
Practice Address - Street 1:6020 DAWSON BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1229
Practice Address - Country:US
Practice Address - Phone:770-662-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health