MEDICARE: ENLIGHT PSYCHOLOGICAL & ASSESSMENT SERVICES, 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1689537516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIGHT PSYCHOLOGICAL & ASSESSMENT SERVICES, PLLC

Provider Business Mailing Address
First Line	:	103 TEAL CT
Second Line	:
City	:	SNEADS FERRY
State	:	NC
Zip	:	28460-7616
Country	:	US
Telephone Number	:	540-273-8498
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 DOCTORS DR STE M
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6308
Country	:	US
Telephone Number	:	910-526-0326
Fax Number	:	910-954-1449

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINE MARRO
Credential	:	MA, LPA
Telephone Number	:	540-273-8498

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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