Healthcare Provider Details

I. General information

NPI: 1437900628
Provider Name (Legal Business Name): MARISSA HALL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA PARKER

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 SIX FORKS RD STE 221
RALEIGH NC
27609-4468
US

IV. Provider business mailing address

5306 SIX FORKS RD STE 221
RALEIGH NC
27609-4468
US

V. Phone/Fax

Practice location:
  • Phone: 919-355-6502
  • Fax:
Mailing address:
  • Phone: 919-355-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020268
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: