Healthcare Provider Details

I. General information

NPI: 1154973170
Provider Name (Legal Business Name): KAYLEE MARIAN MARINO LPCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KAYLEE MARIAN COUSER

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 RIDGEFIELD BLVD
ASHEVILLE NC
28806-6209
US

IV. Provider business mailing address

24 WATERFORD CT
ASHEVILLE NC
28806-2129
US

V. Phone/Fax

Practice location:
  • Phone: 828-670-7723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA14783
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: