Provider Demographics
NPI:1285998104
Name:FLETCHER, MARINIC EATMON (LPC, LCAS-A, NCC)
Entity type:Individual
Prefix:
First Name:MARINIC
Middle Name:EATMON
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LPC, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-4924
Mailing Address - Country:US
Mailing Address - Phone:919-697-1078
Mailing Address - Fax:
Practice Address - Street 1:425 HIDDEN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4924
Practice Address - Country:US
Practice Address - Phone:919-697-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8290101YP2500X
NC2461-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)