Healthcare Provider Details

I. General information

NPI: 1063335933
Provider Name (Legal Business Name): MARISSA SNOWDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 S MCPHERSON CHURCH RD
FAYETTEVILLE NC
28303-5369
US

IV. Provider business mailing address

801 NIGHTHAWK PL
FAYETTEVILLE NC
28314-5653
US

V. Phone/Fax

Practice location:
  • Phone: 573-300-0302
  • Fax:
Mailing address:
  • Phone: 573-300-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: