MEDICARE: SCARS AND STRIPES THERAPEUTICS & CONSULTING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1104671890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCARS AND STRIPES THERAPEUTICS & CONSULTING PLLC

Provider Business Mailing Address
First Line	:	3041 BERKS WAY STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6777
Country	:	US
Telephone Number	:	919-764-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 BERKS WAY STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6777
Country	:	US
Telephone Number	:	919-764-0702
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	ALLISSA MARQUEZ
Credential	:	PHD
Telephone Number	:	919-764-0702

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	01/26/2026

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