Healthcare Provider Details

I. General information

NPI: 1588378731
Provider Name (Legal Business Name): MARISSA PINTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 BLAKMARAL LN
MILTON GA
30004-3400
US

IV. Provider business mailing address

13525 BLAKMARAL LN
MILTON GA
30004-3400
US

V. Phone/Fax

Practice location:
  • Phone: 678-628-4505
  • Fax:
Mailing address:
  • Phone: 678-628-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: