Healthcare Provider Details

I. General information

NPI: 1285998104
Provider Name (Legal Business Name): MARINIC EATMON FLETCHER LPC, LCAS-A, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HIDDEN SPRINGS DR
DURHAM NC
27703-4924
US

IV. Provider business mailing address

425 HIDDEN SPRINGS DR
DURHAM NC
27703-4924
US

V. Phone/Fax

Practice location:
  • Phone: 919-697-1078
  • Fax:
Mailing address:
  • Phone: 919-697-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2461-A
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8290
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: