=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306219621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TINA EVELYN MARQUETTE LCSW, MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2015
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50101 GOVERNORS DR STE 280
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27517-9517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-530-0200
-----------------------------------------------------
Fax | 919-808-4307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50101 GOVERNORS DR STE 280
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27517-9517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-530-0200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C011254
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------