Healthcare Provider Details

I. General information

NPI: 1497273049
Provider Name (Legal Business Name): MARISA GABRIELLE SCHORR LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 MCCONNELL ST
JEFFERSON NC
28640-9772
US

IV. Provider business mailing address

PO BOX 208
JEFFERSON NC
28640-0208
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-9449
  • Fax: 336-846-2025
Mailing address:
  • Phone: 336-246-9449
  • Fax: 336-982-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5115
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: