Basic Information
| Provider Information | |||||||||
| NPI: | 1629056098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCDP LMHC LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PERRY | ||||||||
| OtherFirstName: | MARION | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 146 ANOKA ST | ||||||||
| Address2: | |||||||||
| City: | BARRINGTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083361113 | ||||||||
| FaxNumber: | 5083363402 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 W US HIGHWAY 64 | ||||||||
| Address2: | |||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289068115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288370071 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4204 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | MHC00067 | RI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 10135 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | LCDP00058 | RI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 62-01839 | 01 | UBH | OTHER | 2311-2 | 01 | RI | BLUE CROSS | OTHER | MJ25549 | 05 | RI | MEDICAID | 1037130 | 01 | MA | BEACON | OTHER | 406491 | 01 | BLUE CHIP | OTHER | 1037130 | 01 | BEACON | OTHER | LM1061 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 259828 | 01 | COMPSYCH | OTHER |