Provider Demographics
NPI:1154750404
Name:MARSH, MARY ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MARSH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 680427
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0008
Mailing Address - Country:US
Mailing Address - Phone:336-903-6814
Mailing Address - Fax:336-667-4457
Practice Address - Street 1:1917 W PARK DR # A
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3585
Practice Address - Country:US
Practice Address - Phone:336-903-6814
Practice Address - Fax:336-667-4457
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0084681041C0700X
NCC0106501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical