Provider Information for 1548568264
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Ms. NIA MARLETTA ROSE LMHC
Sex: Female
NPI: 1548568264
Last Updated: 2021-05-14
Certification Date: 2021-04-20
Certification Date: 2021-04-20
Details
Name | Value | ||||||||||||
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NPI | 1548568264 | ||||||||||||
Enumeration Date | 2011-03-03 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 219 LEPHILLIP COURT NE CONCORD, NC 28025-2900 United States Phone: 704-721-5551 | Fax: | ||||||||||||
Primary Practice Address | 219 LEPHILLIP COURT NE CONCORD, NC 28025-2900 United States Phone: 704-721-5551 | Fax: | ||||||||||||
Secondary Practice Address(es) | 3107 HANGING ROCK CT E | ||||||||||||
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