Provider Demographics
NPI:1417474925
Name:MARINE, LINDSAY ANN (LCPC, CAC-AD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANN
Last Name:MARINE
Suffix:
Gender:F
Credentials:LCPC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 RIVERSIDE DR STE 8
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5352
Mailing Address - Country:US
Mailing Address - Phone:410-548-3333
Mailing Address - Fax:410-543-3341
Practice Address - Street 1:540 RIVERSIDE DR STE 8
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5352
Practice Address - Country:US
Practice Address - Phone:410-548-3333
Practice Address - Fax:410-548-3341
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
MD101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609500300Medicaid