Healthcare Provider Details

I. General information

NPI: 1053025486
Provider Name (Legal Business Name): MARISSA HULMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W WELSH POOL RD STE 102
EXTON PA
19341-1233
US

IV. Provider business mailing address

80 W WELSH POOL RD STE 102
EXTON PA
19341-1233
US

V. Phone/Fax

Practice location:
  • Phone: 856-776-8515
  • Fax:
Mailing address:
  • Phone: 856-776-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: