Provider Demographics
NPI:1427599380
Name:MARSACK, CHRISTINA NOEL (LMSW)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:NOEL
Last Name:MARSACK
Suffix:
Gender:F
Credentials:LMSW
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 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:
Practice Address - Street 1:710 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1820
Practice Address - Country:US
Practice Address - Phone:810-599-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-12
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical