Provider Demographics
NPI:1194797092
Name:LOUIS, MARY L (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COMMERCE ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5027
Mailing Address - Country:US
Mailing Address - Phone:252-355-2768
Mailing Address - Fax:252-355-0403
Practice Address - Street 1:107 COMMERCE ST STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5027
Practice Address - Country:US
Practice Address - Phone:252-355-2768
Practice Address - Fax:252-355-0403
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC001736104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133CMOtherBCBS NC
NC6003563Medicaid
NC6003563Medicaid
NC2864097AMedicare ID - Type Unspecified