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General NPI Number Information
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NPI Number | 1164099875
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Entity Type | Individual
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Provider Name | MARISSA AMBER MARLIN LPC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 250 SMOKEY LN
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2506
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Country | US
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Telephone | 501-291-2024
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Fax |
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Provider Business Mailing Address
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Address Line | 4535 GRAHAM DR
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City | CONWAY
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State | AR
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Zip | 72034-8205
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Country | US
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Telephone | 870-378-2828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P2311009
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License Number State | AR
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