Provider Demographics
NPI:1558116715
Name:STONE, MARIESA LEIGH (BS)
Entity type:Individual
Prefix:
First Name:MARIESA
Middle Name:LEIGH
Last Name:STONE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PIN OAK DR APT A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8673
Mailing Address - Country:US
Mailing Address - Phone:931-551-1511
Mailing Address - Fax:
Practice Address - Street 1:495 DUNLOP LN STE 106
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5296
Practice Address - Country:US
Practice Address - Phone:931-347-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor