Provider Demographics
NPI:1588364590
Name:LINCOLN, MARISSA RENAE (BT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:RENAE
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WHITE PINES DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5658
Mailing Address - Country:US
Mailing Address - Phone:808-429-2893
Mailing Address - Fax:
Practice Address - Street 1:4920 ROSWELL RD STE 1
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-2684
Practice Address - Country:US
Practice Address - Phone:470-258-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician