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General NPI Number Information
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NPI Number | 1174291355
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Entity Type | Individual
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Provider Name | MARISSA KRIS LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 13125 RIVERS BEND BLVD # 110
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City | CHESTER
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State | VA
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Zip | 23836-2699
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Country | US
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Telephone | 863-604-7748
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 5320 BOX 122
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City | DPO
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State | AE
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Zip | 09726-0122
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50082327
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904015375
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License Number State | VA
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