Provider Demographics
NPI:1962713586
Name:MARQUEZ, MELISSA TATIANA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:TATIANA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:TATIANA
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:299 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1821
Mailing Address - Country:US
Mailing Address - Phone:919-933-8494
Mailing Address - Fax:
Practice Address - Street 1:299 LLOYD ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1821
Practice Address - Country:US
Practice Address - Phone:919-933-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099234181041C0700X
NCC0103791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical